Table of Content

20 August 2022, Volume 25 Issue 24

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Guide·Consensus

Expert Consensus on Immunomodulatory Therapies for Chronic Obstructive Pulmonary Disease

Writing Group for the Expert Consensus on Immunomodulatory Therapies for Chronic Obstructive Pulmonary Disease

2022, 25(24):  2947-2959.  DOI: 10.12114/j.issn.1007-9572.2022.0384

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China has attached importance to the prevention and treatment of chronic obstructive pulmonary disease (COPD) , a major chronic respiratory disease. An in-depth discussion of the immunopathogenesis of COPD and intervening the identified key targets may be new ideas for the prevention and treatment of COPD. Based on the relevant evidence of commonly used immunomodulatory agents for COPD, and the status and trend of development of immunomodulators for COPD, the Writing Group for the Expert Consensus of Immunemodulatory Therapies for Chronic Obstructive Pulmonary Disease proposed the following four recommendations for treating COPD with immunomodulatory therapies: (1) bacterial lysates, phosphodiesterase inhibitors, macrolides and other biological and chemical agents have immunomodulatory efects on COPD by enhancing immune function and immune cell activity; (2) vaccination against influenza and pneumococcal infection could reduce the probability of acute exacerbation of COPD and mortality; (3) statins and vitamin D may be partially effective in COPD owing to their immunomodulatory actions, but need to be verified further due to quite insufficient relevant evidence and reported adverse reactions; (4) Chinese medicine compound and Cordyceps preparations may improve the quality of life and reduce the probability of acute exacerbationsin patients with stable COPD by regulating immune function and improving immune cell activity.The main purpose of this consensus is to greatly promote the clinical treatment of COPD using immunomodulatory therapies in China.

Hot Topics

Research Hotspots of Multidrug-resistant Organisms in China from 2000 to 2020: a Visualization Analysis

Qi ZHANG, Baozhen LI, Xuemei ZHENG, Baohua PING, Xiaoyan WANG, Qian LI

2022, 25(24):  2960-2964.  DOI: 10.12114/j.issn.1007-9572.2021.02.081

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Background

Multidrug-resistant organisms (MDROs) may increase the risk of nosocomial infection and impose great economic burden on patients' families and society. So it is of great significance to analyze the status, especially hotspots of research on MDROs for further research.

Objective

To analyze the research hotspots of MDROs in China from 2000 to 2020.

Methods

CiteSpace and bibliometric methods were used to conduct a visualization analysis of studies related to MDROs included in CNKI database of China in recent 20 years, involving the regularity of growth, high-frequency keywords, evolution of research hotspots and so on.

Results

In all, 3 808 studies were included. The number of these studies published during 2000—2020 demonstrated an upward trend in general, and could be divided into five stages: low output (2000—2004) , slow growth (2005—2009) , rapid growth (2010—2015) , relatively stable growth (2016—2018) and further development (2019—2020) . A total of 221 nodes and 302 edges were found by keywords co-occurrence network analysis. And besides MDROs and multidrug resistance, the central value of other 10 of the top 20 most frequently used keywords was equal or over 0.10, including nosocomial infection, multiple drug-resistant bacterial infections, Pseudomonas aeruginosa, ICU, Escherichia coli, drug resistance, antibiotics, Klebsiella pneumoniae, drug sensitivity test, and intensive care unit. The keywords were clustered into 15 clusters by cluster analysis, mainly included the following four themes: multiple resistant strains, multidrug-resistant bacteria infection and prognosis, diseases leading to multiple drug-resistant bacteria infections, generation mechanism and prevention and control of MDROs. The highly cited burst-related words mainly were drug resistant strains, drug resistance, antibacterial agents, and integron from 2000 to 2013, but there were no burst-related words after 2013.

Conclusion

The number of studies about MDROs in China demonstrated an overall upward trend from 2000 to 2020, with nosocomial infection, antibacterial agents, key drug-resistant strains and integron as the research hotspots, but few of them were about surveillance of drug resistance.

Article

Predictive Model for Long-term Major Adverse Cardiovascular Events in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Qin LI, Xin TAN, Wenxi JIANG, Meng YUAN, Hui NI, Yuan WANG, Jie DU

2022, 25(24):  2965-2974.  DOI: 10.12114/j.issn.1007-9572.2022.0237

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Background

Risk stratification for acute myocardial infarction (AMI) is important for clinical decision-making and prognosis evaluation. As changes have been found in clinical characteristics and management of AMI, the current existing clinical risk score for AMI may be inapplicable to clinical practice. To effectively implement strategies of individualized management for AMI patients, it is necessary to improve the prediction accuracy of long-term major adverse cardiovascular events (MACEs) in AMI after percutaneous coronary intervention (PCI) .

Objective

To develop a predictive model for long-term MACEs in AMI patients after PCI.

Methods

Among the 1 130 AMI patients treated with PCI in Beijing Anzhen Hospital from January 1 to July 31, 2019, 962 eligible cases were enrolled, and their clinical data and laboratory examination indices were collected. Follow-up of the patients was performed via telephone interviews at a median of 2.4 years. The primary endpoint was a composite of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke, malignant arrhythmia, new heart failure or readmission due to exacerbated heart failure, and unplanned revascularization. Patients were divided into event (122 cases) and non-event (840 cases) groups according to the prevalence of MACEs during the follow-up period. Lasso regression was conducted to identify candidate risk factors of long-term MACEs. Multivariate Logistic regression analysis was used to construct the prediction model and the nomograms. The receiver operating characteristic curve was used to evaluate the discrimination ability of the prediction model. The efficacy of the predictive model was assessed by comparing with that of the Global Registry of Acute Coronary Events (GRACE) score in terms of the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) .

Results

The prevalence of MACEs was 12.7% (122/962) . Five predictive variables were identified by Lasso regression, which included ST-segment deviation, diabetes history, hemoglobin (Hb) , left ventricular ejection fraction (LVEF) , and estimated glomerular filtration rate (eGFR) . The algorithm of the prediction model developed using multivariate Logistic regression was: logit (P) =3.596-0.023×X1-0.014×X2-0.036×X3+0.726×X4+1.372×X5 (X1-X5 indicate Hb, eGFR, LVEF, diabetes, and ST-segment deviation, respectively) . ST-segment deviation, diabetes, LVEF, and Hb were associated with MACEs in AMI patients after PCI (P<0.05) . ST-segment deviation, diabetes, eGFR and Hb were associated with MACEs in ST-segment elevation myocardial infarction (STEMI) patients after PCI (P<0.05) . ST-segment deviation, diabetes, and Hb were associated with MACEs in non-STEMI patients after PCI (P<0.05) . The prediction model exhibited an area under the curve (AUC) of 0.774〔95%CI (0.710, 0.834) 〕 for the training cohort, and an AUC of 0.751〔95%CI (0.686, 0.815) 〕for the testing cohort. The NRI estimated by the predictive model in AMI, STEMI, and non-STEMI patients was 0.493〔95%CI (0.303, 0.682) 〕, 0.459〔95%CI (0.195, 0.724) 〕, and 0.455〔95%CI (0.181, 0.728〕, respectively. The IDI estimated by the predictive model in AMI, STEMI, and non-STEMI patients was 0.055〔95%CI (0.028, 0.081) 〕, 0.042〔95%CI (0.015, 0.070〕, and 0.069〔95%CI (0.022, 0.116) 〕, respectively. The predictive efficiency of the predictive model in the three groups was significantly better than that of the GRACE score (P<0.05) . The predictive model was significantly better than the GRACE score in all participants 〔ΔAUC=0.050, P=0.015; IDI=0.055, 95%CI (0.028, 0.081) , P<0.001; NRI=0.493, 95%CI (0.303, 0.682) , P<0.001) 〕.

Conclusion

Our predictive model containing five factors (ST-segment deviation, diabetes, LVEF, eGFR and Hb) may be useful for early risk stratification and long-term prognosis prediction in patients with AMI after PCI.

Changes in Blood Pressure and Measurement Frequency as Well as Heart Rate in Hypertensive Patients That Needed to Be Medical Observation at Home: a Cross-sectional Study in Wuhan

Yang XI, Ningling SUN, Zhechun ZENG, Jinwen WANG, Jianglian SU

2022, 25(24):  2975-2983.  DOI: 10.12114/j.issn.1007-9572.2022.0120

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Background

There were many hypertensive patients at non-high risk of developing COVID-19 that needed to be medical observation at home, but the changes in their blood pressure and measurement frequency as well as heart rate during the period are still unclear.

Objective

To perform an analysis of the changes in blood pressure and measurement frequency as well as heart rate in hypertensive patients that needed to be medical observation at home.

Methods

Through the iHealth cloud platform, data〔including age, sex, systolic blood pressure (SBP) and diastolic blood pressure (DBP) measured by the iHealth Clear (BPM1) at home, and heart rate〕were collected from December 1st, 2019 to March 27th, 2020, involving all hypertensive patients in Wuhan who had an ID number for consecutively uploading blood pressure readings, and were desensitized for removing the confidential information. The features of blood pressure during the period were analyzed. ARIMAX model was used to assess the association of age, sex, number of confirmed COVID-19 cases per day, cumulative confirmed COVID-19 deaths, time granularity and the traffic control with participants' blood pressure and hear rates.

Results

In total, blood pressure readings of 36 472 measurements by the participants using 1 232 iHealth Clear (BPM1) were collected during the 118-day period. Men demonstrated higher mean SBP, DBP and heart rate than women (P<0.05) . After January 23, 2020, the mean SBP of the participants decreased from (141±19) mm Hg to (138±18) mm Hg (P<0.05) . The analysis using the ARIMAX model revealed that after adjusting for month, week, age and number of confirmed COVID-19 cases per day, male participants showed a decrease in blood pressure (β_SBP=-1.08×10^-3, P=0.028, β_DBP=-6.35×10^-4, P=0.002) , and an increase in heart rate (β_HR=2.02, P=0.003) and measurement frequency (β_times=0.035, P=0.002) . But no significant changes were seen in females (P<0.05) .

Conclusion

In general, among hypertensive patients that needed to be medical observation at home, males were found with higher mean SBP, DBP, heart rate and blood pressure measurement frequency. And these hypertensive patients were found with decreased SBP and DBP after the implementation of traffic control. Using the Internet to store blood pressure data measured by the home blood pressure monitor for data assessment and treatment, is contribute to out-of-hospital management of blood pressure in hypertensive patients, which demonstrates the significance of Internet in combination with healthcare.

Inflammatory Phenotypes and Associated Factors in Bronchial Asthma Patients: a Cross-sectional Survey

Weihong HAN, Huanhuan ZHAO, Xinmin TU, Minghang WANG

2022, 25(24):  2984-2991.  DOI: 10.12114/j.issn.1007-9572.2022.0242

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Background

The various inflammatory phenotypes of asthma, a common heterogeneous respiratory disease, are closely related to the pathogenesis, treatment, and prognosis of the disease. So screening the associated factors of inflammatory phenotypes will be helpful for the evaluation of patient condition and delivery of individualized diagnosis and treatment services.

Objective

To explore the distribution of inflammatory phenotypes and associated factors in bronchial asthma patients, providing a basis for the implementation of individualized diagnosis and treatment of the disease.

Methods

A cross-sectional study design was used. Clinical data of bronchial asthma outpatients and inpatients (n=184) were collected from the First Affiliated Hospital of Henan University of Chinese Medicine from November 2018 to December 2020. Inflammatory phenotypes in the patients were classified into four categories according to the type of inflammatory cells in the induced sputum: neutrophilic asthma (NA) , eosinophilic asthma (EA) , mixed granulocytic asthma (MA) , and paucigranulocytic asthma (PA) . Factors possibly associated with each of the inflammatory phenotypes were screened by three statistical methods (univariate analysis, multivariate Logistic regression analysis, and Spearman rank correlation analysis) , and were determined as the associated factors if they had significant associations with the phenotype by two of the aforementioned three methods.

Results

The prevalence of NA, EA, MA, and PA was 45.7% (84/184) , 20.7% (38/184) , 20.7% (38/184) , and 13.0% (24/184) , respectively. Univariate analysis showed that the prevalence of allergic rhinitis and fractioned exhaled nitric oxide (FeNO) level differed significantly between NA and non-NA patients (P<0.05) . And they also varied significantly between EA and non-EA patients (P<0.05) . There was significant difference in FeNO level between MA and non-MA patients (P<0.05) . There were significant differences in mean age, prevalence of previous respiratory disease and mean FeNO level between PA and non-PA patients (P<0.05) . Multivariate Logistic regression analysis showed that allergic rhinitis〔OR=0.417, 95%CI (0.205, 0.848) 〕 and FeNO〔OR=0.978, 95%CI (0.968, 0.989) 〕were associated with NA (P<0.05) ; FeNO〔OR=1.017, 95%CI (1.009, 1.025) 〕 was associated with EA (P<0.05) ; FeNO〔OR=1.007, 95%CI (1.000, 1.014) 〕was associated with MA (P<0.05) ; BMI〔OR=1.165, 95%CI (1.015, 1.337) 〕 and FeNO〔OR=0.981, 95%CI (0.965, 0.998) 〕were associated with PA (P<0.05) . Spearman rank correlation analysis indicated that NA prevalence decreased with increased allergic rhinitis prevalence and FeNO level (r_s=-0.244, -0.361, P<0.05) ; EA prevalence increased with increased allergic rhinitis prevalence and FeNO level (r_s=0.157, 0.341, P<0.05) ; MA prevalence increased with increased FeNO (r_s=0.236, P<0.05) ; PA prevalence decreased with older age, prevalence of previous respiratory disease and increased FeNO (r_s=-0.156, -0.163, -0.159, all P<0.05) . Based on the above analyses, allergic rhinitis and FeNO were associated factors for both EA and NA; FeNO was associated factors of MA; age, prevalence of previous respiratory disease and FeNO were associated factors of PA.

Conclusion

NA accounted for the largest percentage of the inflammatory phenotypes, while PA accounted for the least. FeNO was the associated factor for each inflammatory phenotype. It has specificity in recognizing EA and MA. FeNO combined with allergic rhinitis was associated with NA and EA. FeNO combined with age was associated with PA.

Disease Coping Styles in Young and Middle-aged Patients with First Acute Myocardial Infarction: a Qualitative Study

Yaoxia LI, Qiaohong YANG, Weiyu QIU, Hongyu YU, Xianzhen HUANG, Qiqi KE

2022, 25(24):  2992-2997.  DOI: 10.12114/j.issn.1007-9572.2022.0172

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Background

Active and effective coping is contributive to the prevention of disease recurrence and delay the development of complications. It has been reported that more than 50% of young and middle-aged patients with acute myocardial infarction (AMI) adopt a negative response to the disease, which negatively influences their prognosis and quality of life. But the underlying personal and sociocultural factors associated with the choice of disease coping styles in this population are still unclear. Self-regulation theory has been extensively used in studies of behaviors, comprehensive intervention, and health promotion in patients with stroke, chronic heart failure, or chronic obstructive pulmonary disease. Currently, there is a lack of research on disease coping style and its influencing factors in young and middle-aged patients with first AMI using the framework of this theory.

Objective

To explore disease coping styles in young and middle-aged patients with first AMI using the four-component framework of self-regulation theory.

Methods

Purposive sampling was used to recruit young and middle-aged patients with first AMI from the First Affiliated Hospital of Jinan University from January to June 2021. They were invited to attend an individual, semi-structured interview guided using an outline determined based on our research team members and experts' consensuses on the analysis results of a relevant pre-interview. The interview was conducted till data saturation, and the interview results were analyzed using Colaizzi's phenomenological methodology.

Results

Altogether, the study included 15 cases. Two themes arose from the results of interview with them: (1) the coexistence of positive coping (adjustment of mentality, emotional control, positive attitude towards AMI, self-motivation, lifestyle change, exploring a new way to achieve psychological balance) and negative coping (tolerance, avoidance, reluctant acceptance, submission, concealment) ; (2) influencing factors of coping styles (social support, prognosis estimation, behavioral benefit acquisition, and the powder of role models) .

Conclusion

Both positive and negative methods for coping with first AMI were found in the young and middle-aged patient population, and the negative coping cannot be overlooked. To improve the physical and mental recovery of these patients via reducing patients' negative coping styles and increasing their positive coping styles, medical workers should guide the patients and their families to make full use of the social support system, provide them with individualized health education and education on benefits of healthy behaviors through multiple ways, and set a good example of leadership, motivation and supervision.

Comparative Analysis of Several Common Screening and Assessment Scales for Childhood Autism Spectrum Disease

Zhengting CAI, Lianxin HU, Zefeng WANG, Guangdong XIE, Xianwei LIN

2022, 25(24):  2998-3004.  DOI: 10.12114/j.issn.1007-9572.2022.0231

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Given the increasing prevalence of childhood autism spectrum disease (ASD) , there is a need for scales with higher efficiencies for scientifically screening and assessing this disease. We reviewed several common screening and assessment scales for childhood ASD in terms of applicable age group, applicable methods, scoring methods, assessment criteria and basic contents, and made a comparative analysis of the merits and limitations of characteristics, applications, sensitivity and specificity of commonly used primary and secondary screening scales, as well as diagnostic scales. Then we intensively analyzed and reconstructed these scales from both perspectives of professional use and family use, attempting to explore a screening and assessment method for childhood ASD, thereby alleviating the shortage of professionals, improving the accuracy of screening and diagnosis, reducing the misdiagnosis rate and false positive rate, and providing a reliable scientific basis for the collection of early intervention data and later treatment of childhood ASD.

Amide Proton Transfer-weighted Imaging of Patients with Alzheimer's Disease

Jingwei LI, Qun LI, Shuo YANG, Zhirong RAN, Mingming ZHENG, Nannan ZHU, Peng CHENG, Yuanyuan CHEN, Li SHI, Xulai ZHANG

2022, 25(24):  3005-3012.  DOI: 10.12114/j.issn.1007-9572.2022.0093

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Background

Alzheimer's disease (AD) prevalence is increasing as aging advances worldwide, but its diagnosis is difficult due to atypical early clinical symptoms. Therefore, exploring new and reliable imaging techniques to improve early diagnosis rate of AD has become an important challenge in medical research.

Objective

To assess the correlation of amide proton content in brain with clinical symptoms of AD.

Methods

41 AD patients over 55 years old in Affiliated Psychological Hospital of Anhui Medical University were enrolled from November 2019 to August 2021, and 37 healthy volunteers were recruited at the same time. The Mini-Mental State Examination (MMSE) and the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) were used to evaluate the cognitive function, and behavioral symptoms, respectively. APTw MRI was used to take cephalograms. Spearman rank correlation analysis was used to explore the relationship between content of brain amide protons and psychiatric symptom factors in AD patients.

Results

(1) The results showed that the MMSE and BEHAVE-AD scores were significantly different between AD patients and healthy controls (P<0.05) . AD patients had significantly increased contents of amide protons in the right, left, and total hippocampus under 2 ut, and in the right, left and total hippocampus under 4 ut, than did healthy controls (P<0.05) . But the contents of amide protons in the left and total hippocampus under 3 ut in AD patients were lower than those in healthy controls (P<0.05) . (2) Spearman rank correlation analysis showed that the content of amide protons in the right hippocampus under 2 ut was positively correlated with the scores of delusional ideation factor (r_s=0.574, P=0.040) and hallucinations factor (r_s=0.595, P=0.032) and diurnal rhythm disturbances factor (r_s=0.591, P=0.033) . Under 3 ut, the content of amide protons in the right hippocampus was positively correlated with the scores of delusional ideation factor (r_s=0.588, P=0.034) and hallucinations factor (r_s=0.572, P=0.041) and diurnal rhythm disturbances factor (r_s=0.650, P=0.016) , whereas content of amide protons in the left hippocampus was negatively correlated with the score of spatial orientation (r_s=-0.590, P=0.034) . The amide proton content in the total hippocampus under 3 ut was positively correlated with scores of delusional ideation factor (r_s=0.625, P=0.022) and hallucinations factor (r_s=0.606, P=0.028) and diurnal rhythm disturbances factor (r_s=0.611, P=0.026) . Under 4 ut, the content of amide protons in the right hippocampus was positively correlated with the score of emotion factor (r_s=0.615, P=0.025) , whereas content of amide proton in the left hippocampus was negatively correlated with scores of temporal orientation (r_s=-0.570, P=0.042) , attention (r_s=-0.570, P=0.042) , and remote memory (r_s=-0.732, P=0.004) . The amide proton content in the total hippocampus under 4 ut was positively correlated with score of emotion factor (r_s=0.580, P=0.038) .

Conclusion

We found that there were abnormal changes in the content of amide protons in the hippocampus of AD patients, which may be related to the patients' cognitive fuction and psychotic symptoms. This study may provide a new idea for clinical diagnosis of AD.

Changes and Response Predictive Values of Serum miR-210 and miR-181a in Stable Chronic Obstructive Pulmonary Disease Patients Treated with Glucocorticoid Therapy

Ke QIN, Tonglin LI, Shuai GONG, Meifang JIANG

2022, 25(24):  3013-3017.  DOI: 10.12114/j.issn.1007-9572.2022.0238

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Background

There are rare studies assessing the efficacy of inhaled glucocorticoids (ICS) , the common therapy for chronic obstructive pulmonary disease (COPD) . MicroRNAs (miRNAs) have been confirmed to be involved in the development of COPD, among which miR-210 and miR-181a are closely related to COPD. Moreover, there is lack of clinical research on changes of miR-210 and miR-181a in COPD patients treated with ICS.

Objective

To examine the changes and response predictive values of serum miR-210 and miR-181a levels in stable COPD patients treated with ICS.

Methods

Eighty-six COPD outpatients were recruited from 363 Hospital from January 2017 to June 2020. All of them received four-week budesonide and formoterol inhalation. Treatment efficacy was assessed by the results of spirometry test or COPD Assessment Test (CAT) 〔responsive to treatment was defined as the COPD stage was reduced at least one stage or CAT score was reduced at least 2 points after treatment〕. Pre- and post-treatment lung function parameters〔including forced expiratory volume in one second (FEV₁) , forced vital capacity (FVC) , and peak expiratory flow (PEF) 〕 and serum miR-210 and miR-181a levels were collected. Pearson correlation analysis was used to assess the associations of serum miR-210 and miR-181a levels with FEV₁, FVC, and PEF as well as CAT score before and after the treatment. ROC analysis was used to assess the predictive values of serum miR-210 and miR-181a levels for treatment response in stable COPD.

Results

Compared with pre-treatment, stable COPD patients demonstrated significantly increased values of FEV₁, FVC, and PEF, and significantly decreased CAT score, serum miR-210 and miR-181a levels after treatment (P<0.05) . Serum miR-210 and miR-181a levels were positively correlated with the CAT score before the treatment (P<0.05) . Serum miR-210 and miR-181a levels were negatively correlated with FEV₁ after the treatment (P<0.05) . Patients with responses to treatment had significantly lower pre- and post-treatment serum miR-210 and miR-181a levels compared with those without (P<0.05) . In predicting the treatment response in stable COPD, the AUC of pre-treatment serum miR-210 level was 0.807, and that of pre-treatment serum miR-181a level was 0.844 (P<0.05) .

Conclusion

The serum levels of miR-210 and miR-181a were much lowered in stable COPD patients with responses to four-week budesonide and formoterol inhalation. Pre-treatment serum miR-210 and miR-181a levels might be effective predictors of treatment response.

Clinical Investigation about Relationship between Neurological Paroxysmal Disorders and Patent Foramen Ovale

Yangzhou XU, Yaping LI, Heng YANG, Hui YE, Zhihui ZHANG, Zhi SONG

2022, 25(24):  3018-3021.  DOI: 10.12114/j.issn.1007-9572.2022.0094

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Background

Both neurological paroxysmal disorders and patent foramen ovale (PFO) are characterized by episodic nature, and at present, the relationship between neurological paroxysmal disorders and PFO is not clear.

Objective

To investigate the possible relationship between neurological paroxysmal disorders and PFO.

Methods

A cross-sectional study method was used. Transthoracic cardiac ultrasound was performed on all patients with neurological paroxysmal disorders from the Third Xiangya Hospital of Central South University, who were classified into groups as migraine (n=266) , epilepsy (n=286) , syncope (n=187) , vertigo (n=68) , transient ischemic attack (TIA) (n=48) , according to the main clinical diagnosis. The PFO positive rate at different ages within and between groups was compared with the overall PFO positive rate of the population.

Results

Transthoracic cardiac ultrasound was completed in a total of 1 030 patients, and a total of 390 patients were PFO with a positive rate of 37.9%. According to RLS grade of 340 PFO positive patients in different groups, 109 cases were RLS 1 grade, accounting for 32.1%; 148 cases were RLS 2 grade, accounting for 43.5%; 83 cases were RLS 3 grade, accounting for 24.4%. There was no significantly difference in RLS grades in different groups (P>0.05) . The PFO positive rates in the migraine, epilepsy, syncope, vertigo and TIA group were 46.2%, 40.6%, 35.8%, 33.8%, 22.9%, respectively. The PFO positive rate of the migraine, epilepsy, and syncope group was higher than the overall PFO positive rate of the population, respectively (P<0.05) ; in the migraine, epilepsy, syncope and vertigo group, the PFO positive rate over 11 years, 21 years and 31 years was higher than the overall PFO positive rate in the population, respectively (P<0.05) .

Conclusion

There might be a clinical association between PFO and migraine, epilepsy and syncope. It may be more meaningful to screen PFO in younger patients, but the mechanism of which needs to be further investigated.

The Pathogen Spectra of Infections with Hematological Diseaes Detected Using Metagenomic Next Generation Sequencing

Ruli PANG, Meiqing WU, Zeyan SHI, Yu LIN, Yanyun SU, Baowen ZHOU, Ziwen BAI, Weihua ZHAO

2022, 25(24):  3022-3028.  DOI: 10.12114/j.issn.1007-9572.2022.0007

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Background

As infection is a common complication and cause of death in hematological disease, early detection of microorganisms causing infections is particularly important for the improvement of prognosis. The newly emerged metagenomic next-generation sequencing (mNGS) technology has the advantages of simple operation, small sample size required, fast detection, unsusceptible to contamination. Moreover, it has better performance than culture methods in detecting marginal microorganisms.

Objective

To determine the causes of infections in patients with hematological diseases via analyzing the bacterial and viral pathogen spectra of infections in such patients detected using mNGS, to inform relevant clinical treatment.

Methods

Participants (n=53) were hematological disease patients who had clinical infections or suspected infections symptoms during the hospitalization in Department of Hematology, the First Affiliated Hospital of Guangxi Medical University from August 2018 to December 2020. Samples collected from them included whole blood, cerebrospinal fluid, pleural effusion, tissue, abdominal drainage fluid, joint fluid, sputum, fluid aspirated by puncture of the right lower extremity. For detecting microorganisms causing infections, mNGS technology was used for all patients (58 samples) , culture was used for 52 patients (55 samples) , G/GM test was used for 46 patients (50 samples) , and PCR test was used for 44 patients (48 samples) as well.

Results

The bacterial and viral pathogen spectra of infections detected by mNGS technology showed that the most common Gram-positive bacteria were Propionibacterium acnes (42 times) , Staphylococcus epidermidis (33 times) , and Staphylococcus hominis (32 times) , the most common Gram-negative bacteria were Acinetobacter johnsonii (26 times) , Burkholderia vietnamiensis (20 times) , and Burkholderia ubonensis (19 times) , the most common fungus was Malassezia restricta (28 times) , and the most common viruses were Cytomegalovirus (26 times) , Epstein-Barr virus (14 times) and Torque teno virus (19 times) . Toxoplasma gondii was detected in the blood and cerebrospinal fluid of a patient with severe thalassemia after hematopoietic stem cell transplantation. Compared to culture method, G/GM test, and PCR test, mNGS technology had a higher detection rate (P<0.05) . The medication of 6 patients were adjusted according to the detection results of mNGS, and 4 of them were much improved, but the other 2 cases were still poorly treated.

Conclusion

This study indicates that mNGS technology is contributive to the determination of causes of clinical infections and guidance on treatment in patients with hematological diseases. However, due to possible false positive and false negative rates in the detection by mNGS, mNGS technology is recommended to be used in combination with other detection methods, which could reduce the possibility of misdiagnosis.

A Comparative Study of Four Nutritional Evaluation Methods in Prognostic Evaluation of Elderly Patients with Chronic Heart Failure

Huahua HUANG, Tao TIAN, Dongmei ZHANG, Hong LIU, Xubo LI, Wenyuan MA

2022, 25(24):  3029-3035.  DOI: 10.12114/j.issn.1007-9572.2022.0207

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Background

Chronic heart failure is a syndrome occurring at the end-stage of multiple cardiovascular diseases. In the condition, nutritional and metabolic problems such as loss of appetite, diarrhea, abdominal distension, and constipation are highly prevalent, which in turn affect the prognosis of heart failure. The relationship of nutritional assessment results with prognosis in chronic heart failure has been studied extensively, while nutritional assessment for older adults with chronic heart failure has been rarely studied, and there is no clinically recognized assessment method.

Objective

To perform a comparative analysis of four nutritional assessment methods in terms of clinical prognosis prediction in elderly patients with chronic heart failure.

Methods

Eligible older inpatients with chronic heart failure (n=199) were recruited from Department of Cardiology, ICU, and Department of Geriatrics, Linyi People's Hospital from June 2018 to June 2020. Data were collected via reviewing the medical records and telephone-based follow-ups, including sex, age, height, weight, serum albumin (ALB) level, BMI, Geriatric Nutritional Risk Index (GNRI) , and result of Nutrition Risk Screening 2002 (NRS2002) , as well as prognosis〔containing three classifications: in-hospital deaths (n=43) and in-hospital survivors (n=156) ; one-year deaths (n=51) and one-year survivors (n=148) ; readmission within half a year (n=69) and readmission after half a year (n=130) 〕. Multivariate Logistic regression analysis was used to explore the prognostic factors of chronic heart failure. The analysis of ROC curve with AUC value was carried out to comparatively estimate prognosis predictive values of the nutritional assessment methods.

Results

There were significant differences in mean age, serum ALB, GNRI and NRS2002 score between in-hospital deaths and survivors (P<0.05) . The mean age, height, serum ALB, GNRI and NRS2002 score were also significantly different between one-year deaths and survivors (P<0.05) . Those with readmission within half a year had significantly different mean BMI, serum ALB, GNRI and NRS2002 score compared with those with readmission after half a year (P<0.05) . For predicting in-hospital death, the AUC of serum ALB was 0.76〔95%CI (0.68, 0.84) , P<0.001〕, and that of NRS2002 score was 0.80〔95%CI (0.73, 0.86) , P<0.001〕. In predicting one-year death, the AUC of serum ALB was 0.75〔95%CI (0.67, 0.82) , P<0.001〕, and that of NRS2002 score was 0.82〔95%CI (0.76, 0.88) , P<0.001〕. The AUC of NRS2002 score in predicting readmission within half a year was 0.73〔95%CI (0.65, 0.80) , P<0.001〕.

Conclusion

On the whole, NRS2002 score could be the first choice for prognostic assessment in elderly patients with chronic heart failure, for it was more effective in predicting the risks of in-hospital death, one-year death and readmission within half a year than serum ALB level, GNRI and BMI.

Classification and Comparative Analysis of Prediction Models for Postpartum Depression

Yongjian WANG, Weijing QI, Yipeng WANG, Sha HUANG, Cong LI, Na WEI, Jie HU

2022, 25(24):  3036-3042.  DOI: 10.12114/j.issn.1007-9572.2022.0209

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Postpartum depression (PPD) is a common maternal mental health issue induced by a combination of biopsychosocial factors, which seriously affects the physical and mental health of mothers and infants. Screening for individual maternal risk factors during pregnancy for predicting PPD will contribute to early identification and treatment of PPD. Many prediction models have been developed and extensively used in the research on the etiology of PPD, and classifying and comparing different types of the models could provide an important reference for selecting a rational method for developing the model, and help to increase the forms of PPD screening and diagnosis.

Development and Application Assessment of a Clinical Diagnostic Scoring System for Tuberculous Meningitis

Peng ZHANG, Yanping HUANG, Mingjia LIN, Wenjuan JING, Zhongsheng JIANG

2022, 25(24):  3043-3048.  DOI: 10.12114/j.issn.1007-9572.2022.0087

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Background

Tuberculous meningitis (TM) is a common intracranial infection with high misdiagnosis rate due to slow onset, atypical symptoms and difficult etiological diagnosis. There are few available effective diagnostic tools for TM. Developing a diagnostic scoring system based on the common symptoms and examination findings of TM may help to improve the diagnostic accuracy and reduce the misdiagnosis rate regarding TM.

Objective

To establish a clinical diagnostic scoring system for TM and to evaluate its application value.

Methods

One hundred and eighty-seven inpatients with a diagnosis of meningitis were selected from Department of Infectious Diseases, Liuzhou People's Hospital from November 2011 to September 2021, and randomly divided into a model group (n=147, including 71 with TM, and 76 with non-TM) and a validation group (n=40) by a SPSS (version 21.0) algorithm. General data of all cases were collected, mainly including sex, age, clinical symptoms (fever, headache, disturbance of consciousness, cervical resistance) , laboratory and imaging examination results〔including prevalence of HIV infection, CD₄⁺ T lymphocyte count, C-reactive protein, intracranial pressure and routine cerebrospinal fluid (CSF) biochemical markers (glucose, chlorine, protein and cell number) 〕. The influencing factors of TM in the model group were identified using Multivariate Logistic regression, and were used to develop a diagnostic scoring system for TM with each factor rated according to its β coefficient. Then its predictive value for TM was tested using the receiver operating characteristic (ROC) curve.

Results

TM and non-TM patients in the model group had statistically significant differences in the prevalence of headache and HIV infection, CD₄⁺ T lymphocyte count less than 200/μl, elevated C-reactive protein, intracranial pressure greater than 200 mm H₂O, decreased glucose and chlorine in CSF, elevated protein and monocytes in CSF (P<0.05) . Multivariate Logistic regression analysis revealed that headache, CD₄⁺ T lymphocyte cell count less than 200/ μl, elevated C-reactive protein, decreased CSF glucose, and elevated CSF protein were associated with TM (P<0.05) . Based on our clinical practical experience, CSF chlorine and monocytes were added in the multivariate Logistic regression, and further analysis found that headache, CD₄⁺ T lymphocyte count less than 200/μl, elevated C-reactive protein, decreased CSF glucose, and elevated CSF protein were still the associated factors of TM (P<0.05) . The clinical diagnostic scoring system for TM was developed using the aforementioned 7 factors with their values assigned based on the β coefficient value for scoring, among which the assigned value for decreased CSF was 1 point, and the assigned value for each of the other six factors was calculated using that of decreased CSF multiplying the corresponding multiples. For the ease of clinical use, the assigned values for both headache and CD₄⁺ T lymphocyte count less than 200/μl were increased by 2.5 points since the original assigned values of them were negative. The area under the curve (AUC) of the clinical diagnostic scoring system for TM in predicting TM in model group was 0.807〔95%CI (0.735, 0.879) , standard error=0.037, P<0.001〕with 21.50 points as the optimal cut-off value. And that of the system in predicting TM in the validation group was 0.766〔95%CI (0.610, 0.921) , standard error=0.079, P=0.004〕, with sensitivity of 0.789 and specificity of 0.667.

Conclusion

The clinical diagnostic scoring system for TM developed using seven factors is simple and easy-to-use, which has proven to be effective in early diagnosis of TM.

Evidence-based Medicine

Associated Factors of Cognitive Impairment 3 to 6 Months after Ischemic Stroke: a Meta-analysis

Aijie TANG, Xiujuan DAI, Xinmiao HU, Xiayun WANG, Qian WU

2022, 25(24):  3049-3056.  DOI: 10.12114/j.issn.1007-9572.2021.02.008

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Background

Expert Consensus on the Management of Cognitive Impairment after Stroke 2021 has made it clear that, post-stroke cognitive impairment (PSCI) prevalence needs to be assessed by cognitive assessment 3-6 months after stroke, but the influencing factors found by existing studies are still controversial and need the support of EBM evidence.

Objective

To investigate the influencing factors of cognitive impairment 3 to 6 months after ischemic stroke, to provide an evidence-based reference for the prevention and intervention of PSCI.

Methods

We searched databases of the Cochrane Library, PubMed, EMBase, CINAHL, Web of Science, CNKI, SinoMed, VIP and Wanfang Data for cohort studies or case-control studies about influencing factors of cognitive impairment 3 to 6 months after ischemic stroke from inception to December 2020. RevMan5.3 software was used to conduct the Meta-analysis.

Results

A total of 27 studies were finally included, involving 8 677 patients (4 322 with PSCI and the other 4 355 without) . Meta-analysis results demonstrated that, age〔OR=1.10, 95%CI (1.06, 1.14) , P<0.000 01〕, educational level〔OR=0.82, 95%CI (0.78, 0.85) , P<0.000 01〕, hypertension〔OR=2.69, 95%CI (1.90, 3.81) , P<0.000 01〕, diabetes〔OR=1.95, 95%CI (1.58, 2.39) , P<0.000 01〕, atrial fibrillation〔OR=2.92, 95%CI (1.92, 4.45) , P<0.000 01〕, history of stroke〔OR=2.68, 95%CI (1.95, 3.68) , P<0.000 01〕, Fazakas score〔OR=1.86, 95%CI (1.57, 2.21) , P<0.000 01〕, NIHSS score at admission〔OR=1.44, 95%CI (1.17, 1.77) , P=0.000 6〕, hyperhomocysteinemia〔OR=1.08, 95%CI (1.02, 1.14) , P=0.006〕and drinking〔OR=2.85, 95%CI (2.00, 4.04) , P<0.000 01〕 were associated with cognitive impairment 3 to 6 months after ischemic stroke.

Conclusion

Available evidence suggests that, age, educational level, hypertension, diabetes, atrial fibrillation, history of prior stroke, Fazakas score, NIHSS score at admission, hyperhomocysteinemia and drinking may be associated factors of cognitive impairment 3 to 6 months after ischemic stroke. To reduce the incidence of PSCI, individualized rehabilitation program is suggested to made according to the above-mentioned associated factors for PSCI in combination with the patient's details.

Efficacy of Enteral Nutrition within 24 Hours of Admission in Severe Acute Pancreatitis: a Meta-analysis

Qianqian WANG, Jian ZHOU, Zhiwei JIANG, Guanwen GONG

2022, 25(24):  3057-3064.  DOI: 10.12114/j.issn.1007-9572.2021.02.077

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Background

Enteral nutrition (EN) is one important clinical treatment for severe acute pancreatitis (SAP) , but the optimal timing of initiation remains controversial.

Objective

To evaluate the efficacy of EN within 24 hours of admission in the treatment of SAP by applying a Meta-analysis.

Methods

Databases of PubMed, EMBase, the Cochrane Library, Web of Science, CNKI, VIP, Wanfang Data and SinoMed were searched to identify randomized controlled trials (RCTs) about efficacies of usual care and EN within 24 hours of admission (experimental group) versus usual care in combination with EN or oral eating after 24 hours of admission or parenteral nutrition immediately after admission (control group) in SAP patients included from inception to July 2021. Meta-analysis was performed using RevMan 5.4 software.

Results

A total of 13 RCTs involving 1 193 patients were included. Meta-analysis results revealed that, compared to usual care with control interventions, usual care with EN within 24 hours of admission had better effects on reducing the mortality〔RR=0.61, 95%CI (0.39, 0.95) , P=0.03〕, incidence of multiple organ dysfunction syndrome (MODS) 〔RR=0.56, 95%CI (0.36, 0.86) , P=0.009〕and incidence of pancreatic infections〔RR=0.55, 95%CI (0.33, 0.91) , P=0.02〕, and post-treatment APACHE Ⅱ score〔MD=-2.18, 95%CI (-2.55, -1.80) , P<0.000 01〕. Further subgroup analysis indicated that, usual care with EN within 24 hours of admission was superior to usual care with parenteral nutrition immediately after admission in decreasing the mortality〔RR=0.28, 95%CI (0.11, 0.73) , P=0.009〕, incidence of MODS〔RR=0.40, 95%CI (0.20, 0.79) , P=0.009〕and pancreatic infections〔RR=0.50, 95%CI (0.25, 0.98) , P=0.04〕.

Conclusion

Available evidence showed that, EN within 24 hours of admission had better efficacy for SAP, and initiating EN within 24 hours of admission may be beneficial to the treatment of SAP.

Typical Cases

Morphological Characteristics of Peripheral Blood Cells in Patients with Neutral Lipid Storage Disease with Myopathy and Literature Review

Ying XING, Chengwei PU, Ke SHANG, Chenxue QU

2022, 25(24):  3065-3069.  DOI: 10.12114/j.issn.1007-9572.2022.0185

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Background

Neutral lipid storage disease with myopathy (NLSDM) has obscure onset and nonspecific clinical symptoms. Due to different clinical manifestations, the patients with NLSDM may be seen in neurology, cardiovascular disease and other departments, which may easily lead to missed diagnosis and misdiagnosis. The definitive diagnosis depends on genetic detection, but most patients delay treatment because they cannot be diagnosed in time. The peripheral blood leukocytes of such patients have typical morphological characteristics, which can prompt clinicians to improve genetic testing in time to confirm the diagnosis.

Objective

To investigate the morphological characteristics of peripheral blood cells in NLSDM patients.

Methods

3 NLSDM patients admitted to Peking University First Hospital from June to August 2021 were selected as the subjects, the peripheral blood of the patients was collected to prepare blood smears, and the morphological characteristics of blood cells were observed by Wright-Giemsa staining, neutrophil alkaline phosphatase (NAP) staining, myeloperoxidase (MPO) staining and periodic acid-schiff reaction (PAS) .

Results

Wright-Giemsa staining: several circular vacuoles of different sizes can be seen in the cytoplasm of neutrophils, eosinophils, basophils, and monocytes; NAP: the neutrophil cytoplasm of NLSDM patients was negative, which was significantly different from normal and infected patients, the positive rate and integral value of infected patients were significantly increased; MPO: patients with NLSDM were positive which were similar to healthy individual but weaker than infected patients (the large positive particles covered the nucleus, resulting in unclear nuclear structure) . PAS: there was no significant difference in the positive degree of NLSDM patients, healthy individual and infected patients.

Conclusion

Vacuoles of different sizes can be seen in the cytoplasm of various leukocytes in the peripheral blood of NLSDM patients, while neutrophil vacuoles are different from the toxic changes during infection, which can be preliminarily identified by NAP staining. Such morphological abnormalities are characteristic changes of NLSDM.

Rubinstein-Taybi Syndrome: Clinical and Genetic Analyses of One Case and Literature Review

Xiaomiao WAN, Ling LI, Changwei LIU, Chaohui SHEN, Liwen WU, Suxian ZHOU

2022, 25(24):  3070-3074.  DOI: 10.12114/j.issn.1007-9572.2022.0177

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Rubinstein-Taybi syndrome (RSTS) is a rare autosomal dominant genetic disorder characterized by mental retardation, broad thumbs, and hooked nose and so on. RSTS can cause multiple organ hypoplasia and multiple system hypoplasia (such as endocrine system, digestive system, urinary system, etc.) , and even involve the skin (such as pilomatrixomas, hirsutism, etc.) . Moreover, it has been recently reported to be associated with increased risk of cancer. However, relevant research about RSTS is still very limited. By use of clinical characteristics and genetic testing, only some cases can be diagnosed, and the diagnosis for many other cases additionally requires an in-depth analysis of etiology and pathogenesis of RSTS. This paper reports a suspected RSTS patient treated in the Affiliated Hospital of Guilin Medical University. Whole exome sequencing showed that the patient has a mutation in the CREBBP gene: c.3832G>A (p.Glu1278Lys) , but her parents do not have, indicating that it is a new mutation. By the analysis of the genetic testing result with clinical characteristics, the patient was diagnosed with RSTS. It is very difficult to make a diagnosis of RSTS. By providing a detailed description of clinical features of RSTS, this report is conducive to the study of genotype-phenotype correlation of RSTS, and to clinical diagnosis and treatment of RSTS.