Table of Content

20 September 2022, Volume 25 Issue 27

Previous Issue    Next Issue

Cardiovascular Research Development Report

An Essential Introduction to the Annual Report on Cardiovascular Health and Diseases in China (2021)

Liyuan MA, Zengwu WANG, Jing FAN, Shengshou HU

2022, 25(27):  3331-3346.  DOI: 10.12114/j.issn.1007-9572.2022.0506

Asbtract ( )   HTML ( )   PDF (5482KB) ( )  

Figures and Tables | References | Related Articles | Metrics

The prevalence and incidence of cardiovascular diseases (CVD) are increasing in Chinese residents due to ever-deepening influence of associated risks caused by socioeconomic factors (such as the acceleration of population aging and urbanization) and lifestyle changes (such as recently emerged unhealthy lifestyle factors) . In 2019, CVD-related death accounted for 46.74% and 44.26% of all deaths occurring in China's rural and urban areas, respectively. Two out of every five deaths were due to CVD. It is estimated that about 330 million individuals suffer from CVD in China, among whom the number of those suffering from stroke, coronary heart disease, heart failure, pulmonary heart disease, atrial fibrillation, rheumatic heart disease, congenital heart disease, lower extremity artery disease and hypertension is 13 million, 11.39 million, 8.9 million, 5 million, 4.87 million, 2.5 million, 2 million, 45.3 million and 245 million, respectively. In 2019, the total hospitalization costs were 313.366 billion yuan for cardiovascular and cerebrovascular diseases. The burden of CVD is continually increasing, especially in rural areas. The mortality of coronary heart disease and cerebrovascular disease consistently exceeded the urban level in recent years due to unequal allocation of healthcare resources, low awareness of such diseases and poor compliance to the treatment. In the meantime, great progresses have been made in CVD prevention and control, such as decreased smoking prevalence, improved hypertension control rate, significantly improved clinical diagnosis, treatment and basic research, and enhanced community-based containment of CVD. Moreover, relevant rehabilitation has been increasingly valued, and the research and development of medical devices are in a rapid stage of progress.

Drug Use Guide

Update on the Withdrawal from Long-term Use of Benzodiazepines in Patients with Chronic Insomnia Disorder

Jinxiang CHENG, Liping ZHANG, Changjun SU

2022, 25(27):  3347-3351.  DOI: 10.12114/j.issn.1007-9572.2022.0341

Asbtract ( )   HTML ( )   PDF (1543KB) ( )  

References | Related Articles | Metrics

Benzodiazepines (BZDs) are indicated for the short-term treatment of chronic insomnia disorder, since real-world use of them in large doses for a long time could cause serious side effects. Patients with long-term use of BZDs are prone to BZDs tolerance and dependence, but sudden withdrawal from BZDs can lead to rebound and withdrawal symptoms, resulting in difficulty in withdrawal. We reviewed recent studies about the withdrawal from long-term use of BZDs in chronic insomnia disorder patients, focusing on the overview of BZDs, timing and strategy of withdrawal, and treatment of withdrawal symptoms. Our review will contribute to enriching the ideas of appropriately discontinuing BZDs in chronic insomnia disorder patients with long-term use of BZDs.

Clinical Advances in Ustekinumab in the Treatment of Crohn's Disease

Xin ZHAO, Yingde WANG

2022, 25(27):  3352-3357.  DOI: 10.12114/j.issn.1007-9572.2022.0504

Asbtract ( )   HTML ( )   PDF (1692KB) ( )  

References | Related Articles | Metrics

As the study of inflammatory bowel disease (IBD) advances, various biological agents for IBD are emerging, ushering in a new area of IBD treatment. Ustekinumab, an anti-interleukin-12/23 agent, is a new option for Crohn's disease patients with prior failure of traditional pharmacological treatment or tumor necrosis factor-alpha antagonist (TNF-α) . We reviewed the mechanisms of action, clinical effectiveness, safety, loss of response and the adjustment of therapy regarding ustekinumab in Crohn's disease, and summarized the strengths of ustekinumab treatment, such as rapid onset, significant efficacy and high safety. However, this treatment needs to be further examined by clinical and follow-up studies since it has been used for a short period of time with insufficient clinical evidence.

Article

Clinical Study on Low Attenuation Area Ratio and Pectoral Major Parameters in Evaluating Severity of Pulmonary Ventilation Function Impairmentin Elderly Patients with COPD

Yalin WANG, Jing ZHANG, Muyun ZHU

2022, 25(27):  3358-3364.  DOI: 10.12114/j.issn.1007-9572.2022.0263

Asbtract ( )   HTML ( )   PDF (2471KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Low attenuation area ratio (LAA%) and pectoral major parameters are in elderly patients with COPD related to pulmonary ventilation function, but there are few studies at home and abroad.

Objective

To analyze the correlation of LAA% and pectoral major parameters with impaired pulmonary ventilation function in elderly patients with COPD, and to explore the predictive value of LAA% and PMcsa in the severity of airflow restriction, in order to provide clinical basis for the early detection and diagnosis of COPD.

Methods

A total of 270 elderly patients with stable COPD who underwent chest CT and lung function examination in North Jiangsu People's Hospital affiliated to Yangzhou University from December 2019 to June 2021 were selected and divided into GOLDⅠgroup (FEV_l%pred≥80%, n=47) , GOLD Ⅱgroup (50%≤FEV_l%pred<80%, n=88) , GOLD Ⅲ group (30%≤FEV_l%pred<50%, n=84) and GOLD Ⅳ group (FEV_l%pred<30%, n=51) according to GOLD classification with their general information and CT quantitative indexes recorded. Pearson correlation analysis and multiple linear regression analysis were used to explore the relationship between LAA%, pectoralis major areas (PMcsa) and lung function. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of LAA% and PMcsa for FEV₁%pred<50% and FEV₁%pred<80%.

Results

BMI and PMD in GOLDⅠgroup were higher than those in GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) , and the BMI in GOLD Ⅱgroup and GOLD Ⅲ group was higher than that in GOLD Ⅳ group (P<0.05) . PMcsa, PMI, FEV₁%pred, FEV₁ and FVC in GOLD Ⅰgroup were higher than those in GOLD Ⅱ group, GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) . PMcsa, PMI, FEV₁%pred, FEV₁ and FVC in GOLD Ⅱ group were higher than those in GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) . PMcsa, PMI , FEV₁%pred, FEV₁ and FVC in GOLD Ⅲ group were higher than those in GOLD Ⅳ group (P<0.05) . Left lung LAA%, right lung LAA% and total lung LAA% in GOLD Ⅰ group were lower than those in GOLD Ⅱ group, GOLD Ⅲ group and GOLD Ⅳ group (P<0.05) . Left lung LAA%, right lung LAA% and total lung LAA% in GOLD Ⅱ group were lower than those in GOLDⅢ group and GOLD Ⅳ group (P<0.05) . Left lung LAA%, right lung LAA% and total lung LAA% in GOLD Ⅲ group were lower than those in GOLD Ⅳ group (P<0.05) . FEV₁%pred, FEV₁ and FVC were positively correlated with PMcsa, PMI and PMD (P<0.05) . Both FEV₁%pred and FEV₁ were negatively correlated with low attenuation area ratio (right LAA%, left LAA%, total LAA%) (P<0.05) . Multiple linear regression analysis show that gender, total LAA% and PMcsa were independent influencing factors of FEV₁%pred. The area under ROC curve of right lung LAA%, left lung LAA%, total lung LAA% and PMcsa predicting FEV₁%pred<50% in male patients were 0.832, 0.827, 0.834, 0.809, respectively. The area under ROC curve of right lung LAA%, left lung LAA%, total lung LAA% and PMcsa predicting FEV₁%pred<50% in female patientswere 0.844, 0.801, 0.845, 0.839, respectively. The area under ROC curve of right lung LAA%, Left lung LAA%, total lung LAA% and PMcsa predicting FEV₁%pred<80% in male patients were 0.830, 0.815, 0.831, 0.844, respectively. The area under ROC curve of right lung LAA%, left lung LAA%, total lung LAA% and PMcsa predicting FEV₁%pred<80% in female patients were 0.805, 0.817, 0.807, 0.846, respectively.

Conclusion

The low attenuation area ratio and PMcsa can assess the severity of airflow restriction in elderly patients with COPD, and can be used as an important tool for early screening and severity assessment of COPD.

Total Occlusion of the Culprit Artery in Non-ST-segment Elevation Acute Coronary Syndrome: an Analysis of the Influencing Factors and Long-term Outcome Following Percutaneous Coronary Intervention

Xu CHEN, Hanxiong LIU, Xiuqiong YU, Lianchao CHENG, Lingyao QI, Siqi YANG, Yan LUO, Lin CAI

2022, 25(27):  3365-3372.  DOI: 10.12114/j.issn.1007-9572.2022.0206

Asbtract ( )   HTML ( )   PDF (2258KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

About one-fourth of patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are found with total occlusion of the culprit artery, and their outcomes are poor. However, there is little research in this population in China.

Objective

To identify the possible influencing factors of total occlusion of the culprit artery and long-term outcomes following percutaneous coronary interventions (PCI) in patients with NSTE-ACS.

Methods

Three hundred and seven NSTE-ACS patients with PCI treatment were recruited from the Third People's Hospital of Chengdu from January 2018 to December 2019, among whom, 42 with total occlusion of the culprit artery (pre-PCI TIMI grade 0 or 1, occlusion group) , and other 265 without (pre-PCI TIMI grade 2 or 3, non-occlusion group) . The baseline characteristics and results of regular follow-ups were collected. The endpoints were major adverse cardiac and cerebrovascular events (MACCE) , including all-cause death, recurrent myocardial infarction, revascularization, and new stroke. Multivariate Logistic regression was used to identify the potential influencing factors of total occlusion of the culprit artery. The Kaplan-Meier was used to estimate the cumulative incidence of MACCE. Multivariate Cox regression was adopted to assess the influence of total occlusion of the culprit artery on prognosis.

Results

Compared with non-occlusion group, occlusion group had higher prevalence of non-ST-segment elevation acute myocardial infarction and the left circumflex coronary artery as the culprit vessel, as well as higher levels of hypersensitive troponin T, creatine kinase isoenzyme and B-type natriuretic peptide at admission (P<0.05) . Moreover, occlusion group had lower level of systolic blood pressure and left ventricular ejection fraction (LVEF) , as well as the left anterior descending coronary artery as the culprit vessel at admission (P<0.05) . The results of multivariate Logistic regression analysis showed LVEF〔OR=1.064, 95%CI (1.018, 1.112) , P=0.006〕 was associated with total occlusion of the culprit artery in NSTE-ACS. Occlusion group had higher cumulative incidence of MACCE, revascularization or new stroke than non-occlusion group (P<0.05) . After adjusting for confounding factors, multivariate Cox regression analysis revealed that total occlusion of the culprit artery was associated with MACCE〔OR=2.684, 95%CI (1.229, 5.862) , P=0.013〕 and revascularization〔OR=3.024, 95%CI (1.320, 6.931) , P=0.009〕 in NSTE-ACS.

Conclusion

LVEF may be an associated factor of total occlusion of the culprit artery in patients with NSTE-ACS. Therefore bedside echocardiography is recommended as a routine examination before coronary angiography in patients with NSTE-ACS. In addition, total occlusion of the culprit artery is an influencing factor of MACCE, revascularization, and new stroke in these patients.

Mediating Effect of Exercise on the Relationship between Biased Constitution and Health-related Quality of Life

Wenqiong LIU, Yanbo ZHU, Fanghui MA, Xinrui WU, Yueheng LOU, Xinyuan ZHAO, Yuqiong LI, Liqun LONG, Pipi CHEN

2022, 25(27):  3372-3378.  DOI: 10.12114/j.issn.1007-9572.2022.0205

Asbtract ( )   HTML ( )   PDF (1988KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The pairwise correlation among biased constitution, exercise and health-related quality of life (HRQOL) has been extensively studied, while the relationship among the three has been rarely explored.

Objective

To explore the mediating effect of exercise on the relationship of 8 kinds of biased constitution with HRQOL.

Methods

By use of convenience sampling, unpaid blood donors and their companions were selected as participants from blood donation cabins and blood collecting vehicles of Beijing Red Cross Blood Center from July to November 2015 and May to September 2016 . The exercise level was obtained by the self-report method. The biased constitution was assessed using the Constitution in Chinese Medicine Questionaire (CCMQ) . The HRQOL was evaluated by the Chinese version of the 36-Item Short Form Health Survey (SF-36) , and a higher score indicates a higher quality of life. Pearson correlation analysis was used to explore the correlation among HRQOL (score of SF-36) , exercise level and 8 kinds of biased constitution. Multiple linear regression model was applied to explore the mediating effect of exercise on the relationship between HRQOL and biased constitution.

Results

A total of 1 828 cases attended the survey, 1 771 of them returned questionnaires, and after excluding 29 who inappropriately (incompletely or illogically) answered questionnaires, the remaining 1 742 cases (95.30%) were included for analysis. The mean SF-36 score of 1 742 subjects was (84.42±12.05) points. And the mean scores of the 8 biased constitution subscales of CCMQ for them were: qi-deficiency: (23.20±14.61) points, yang-deficiency: (20.03±18.12) points, yin-deficiency: (20.87±15.20) points, phlegm-dampness: (19.78±14.65) points, dampness-heat: (21.70±16.57) points, blood-stasis: (17.68±14.08) points, qi-depression: (19.63±15.63) points, specific-diathesis: (15.30±13.62) points. The score of each of the 8 kinds of biased constitution was negatively correlated with HRQOL (r: -0.413 - -0.612, P<0.01) . Except for specific-diathesis type, biased constitution scores were negatively correlated with exercise level (r: -0.072 - -0.176, P<0.01) . Exercise level was positively correlated with HRQOL (r=0.145, P<0.01) . Mediation analysis revealed that, exercise played a significant mediating effect on the relationship between HRQOL and biased constitution except the specific-diathesis type (P<0.05) . And the size of mediating effect in a descending order was 2.13% between HRQOL and phlegm-dampness, 2.05% between HRQOL and yang-deficiency, 1.88% between HRQOL and dampness-heat, 1.55% between HRQOL and yin-deficiency, 1.48% between HRQOL and blood-stasis, 1.37% between HRQOL and qi-depression, 1.16% between HRQOL and qi-deficiency.

Conclusion

Eight kinds of biased constitution (phlegm-dampness, yang-deficiency, dampness-heat, yin-deficiency, blood-stasis, qi-depression, qi-deficiency, and specific-diathesis) negatively affected the HRQOL. Although exercise partially played a role in mediating the relationship of HRQOL with the other 7 types of biased constitution except specific-diathesis, the effect size was generally little.

Health-related Quality of Life in Children with Nephrotic Syndrome

Yue ZENG, Yue DU

2022, 25(27):  3379-3383.  DOI: 10.12114/j.issn.1007-9572.2022.0035

Asbtract ( )   HTML ( )   PDF (1703KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Nephrotic syndrome (NS) is a common chronic kidney disease in children, and has a long treatment cycle with being prone to recurrence and refractoriness. Adverse effects caused by therapeutic drugs and concerns about disease prognosis may all affect the child's physical and mental health, and quality of life. Therefore, it is very necessary to understand the Health-related Quality of Life (HRQOL) of children with nephrotic syndrome.

Objective

To understand the level of HRQOL in children with nephrotic syndrome.

Methods

Children (aged 2-18 years) with nephrotic syndrome and their parents were recruited from the Department of Pediatric Nephrology Rheumatism and Immunology, Shengjing Hospital of China Medical University between October 2019 and December 2020. Data were collected on age, gender, disease duration, whether they had frequent relapses, number of relapses, and whether they were prescribed immunosuppressive agents (including cyclophosphamide, tacrolimus, etc.) , place of residence (urban, rural, urban-rural junction areas) . The PedsQL 4.0 core generic scale was used to understand the level of HRQOL (including the child self rating scale and parent report) in children with primary NS.

Results

A total of 183 questionnaires were distributed, and 174 valid questionnaires were returned, with an effective recovery rate of 95.1%. Among the 174 children, 119 were males and 55 were females. Median age was 6 (4, 11) years. There were 100 children with recurrence (57.5%) , with a median number of 3 (1, 5) recurrences. 54 patients had frequent recurrences and 46 patients had non frequent recurrences. 31 patients were treated with immunosuppressants. The usual place of residence was urban in 86 patients, rural in 63 patients, and urban-rural junctions in 25 patients. The ICC of the concordance analysis between the children's self-rating scale and the parent-reported scale were both greater than 0.75. There were no significant differences in physiological scores, emotional scores, social scores, role scores and total scores between genders (P>0.05) . There were statistically significant differences in physiological scores, emotional scores, social scores and total scores among different ages (P<0.05) . However, there was no significant difference in the role scores at different ages (P>0.05) . There were no significant differences in the physiological scores, emotional scores, social scores, role scores, and total scores among different disease durations (P>0.05) . There were no significant differences in the physiological score, emotional score, social score, role score and total score between children with and without frequent recurrence (P>0.05) . The emotional scores, social scores, and total scores were significantly different between children who used immunosuppressants and those who did not use (P<0.05) , and those who did not apply immunosuppressants achieved a higher score. There were no significant differences in the physiological scores, emotional scores, social scores, role scores and total scores among different family residing places (P>0.05) .

Conclusion

The scores of children with NS in physical, emotional, social, and role functioning were reduced. When treating the disease, clinicians need to focus on the children's physical, psychological and social adaptability, and intervene in time to improve their quality of life.

Influencing Factors in Selecting Initial Respiratory Support Strategies in Neonatal Respiratory Distress Syndrome and Early Outcomes of Different Support Strategies in High Altitude Areas

Tongying HAN, Qiongbo YE, Yuzhen DEJI, Haiyun LONG, Chongchong YANG, Li LI, Zhen YU

2022, 25(27):  3384-3389.  DOI: 10.12114/j.issn.1007-9572.2022.0269

Asbtract ( )   HTML ( )   PDF (1888KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

At present, there are a variety of mechanical ventilation mode of breathing for premature infants with respiratory distress syndrome (NRDS) , but the application of these techniques in Tibetan Plateau are limited because of the low air pressure and oxygen content and etc. The NRDS initial breathing support measures can only be performed with INSURE technique (tracheal intubation—injection of pulmonary surfactant—nasal continuous positive airway pressure ventilation after extubation) and invasive mechanical ventilation (MV) . It is currently unclear what factors influence the selection of the NRDS initial breathing support therapy in premature infants in Tibetan Plateau.

Objective

To explore the factors in selection of supporting NRDS initial breathing strategies in high altitude area and evaluate the early clinical outcomes of different supporting strategies.

Methods

The clinical data of 183 premature infants diagnosed with NRDS and their mother's general data in Paediatri neonatal ward of Lhasa People's Hospital from June 2018 to June 2020 were analyzed retrospectively. According to the accepted initial respiratory support mode, they were divided into INSURE group (n=122) and MV group (n=61) . Multifactorial Logistic regression analysis was used to explore influencing factors in selection of NRDS initial breathing support treatment.

Results

The gestational age, birth weight, 1 min, 5 min and 10 min Apgar scores in MV group were lower than those in INSURE group and the proportion of prenatal application of glucocorticoids was higher than that in INSURE group (P<0.05) . The difference was statistically significant after comparing the composition of premature infants of different gestational ages between INSURE group and MV group (P<0.05) . The difference was statistically significant as well after comparing the composition of NRDS 5 min Apgar score between INSURE group and MV group (P<0.05) . The mortality and incidence of pulmonary hemorrhage in MV group were higher than those in INSURE group (P<0.05) . Among the surviving infants, the incidence of bronchopulmonary dysplasia (BPD) in MV group was higher than that in INSURE group〔43.2% (16/37) vs 16.1% (18/112) 〕 (P<0.05) . Multifactoral Logistic regression analysis showed that gestational age, Apgar score at 5 minutes after birth and whether to use prenatal glucocorticoid were influencing factors in selecting MV for premature infants with NRDS (P<0.05) .

Conclusion

In Tibet Plateau, the gestational age at birth, Apgar at 5 minutes after birth and whether to use glucocorticoids before delivery are closely related in the selection of the NRDS initial breathing support strategy.

Application of Two Scoring Systems in Prediction of Postoperative Complications after Radical Resection of Colorectal Cancer

Kaiwei DU, Xia JIANG, Yuanyuan WANG, Yanjie GENG, Tian GAO, Tianhao LAN, Guiqi WANG

2022, 25(27):  3390-3394.  DOI: 10.12114/j.issn.1007-9572.2022.0184

Asbtract ( )   HTML ( )   PDF (1785KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Colorectal cancer is a common tumor, and surgery is still one of the main treatment methods. Nowadays the research on surgical treatment of colorectal cancer is very mature, but that of predicting the possibilities of postoperative complications from preoperative and intraoperative status is scarce.

Objective

To investigate the predictive value of POSSUM system and aCCI index in postoperative complications after radical resection of colorectal cancer.

Methods

Retrospective analysis was performed on the clinical data of 118 patients performed colorectal cancer operation in the First Hospital of Hebei Medical University from June 2016 to September 2020. They were divided into complication group (n=42) and non-complication group (n=76) according to the incidence of postoperative complications. Spearman rank correlation was used to explore the relationship between postoperative complications after radical resection of colorectal cancer and clinical indicators. ROC curve was used to evaluate the predictive value of POSSUM system and aCCI index.

Results

R1, R2, aCCI levels and blood loss in the complication group were higher than those in the non-complication group, while Z and preoperative Hb levels were lower than those in the non-complication group (P<0.05) . TNM staging ratois were compared in the two groups, and the difference was statistically significant (P<0.05) . R1, R2 and Z were predicted to be 0.065 (0.039, 0.131) , 0.349 (0.220, 0.585) and 0.775 (0.214, 0.901) within 30 days. 36.1% (42/118) developed postoperative complications within 30 days after operation, and 1.7% (2/118) died of anastomotic leakage. Postoperative complications were positively correlated with TNM stage and blood loss, and negatively correlated with preoperative Hb (P<0.05) . The area under ROC curve (AUC) of R1, R2 and aCCI indexes for predicting postoperative complications after radical resection of colorectal cancer were 0.727, 0.728 and 0.638, the optimal cut-off values were 0.114, 0.516 and 3.500, the sensitivities were 57.1%, 57.1% and 52.4% respectively, the specificity was 81.6%, 80.3% and 65.8% respectively.

Conclusion

Both POSSUM system and aCCI index have predictive value for the occurrence of complications after radical resection of colorectal cancer and can be used in clinical decision.

Clinical, Pathological and TCM Syndromes of Primary IgA Nephropathy with Malignant Hypertension

Jianghua KE, Shuwei DUAN, Linchang LIU, Shuang LI, Yujing KE, Yilun QU, Jin YAO, Xiangmei CHEN

2022, 25(27):  3395-3403.  DOI: 10.12114/j.issn.1007-9572.2022.0201

Asbtract ( )   HTML ( )   PDF (2985KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

IgA nephropathy (IgAN) is the most common primary glomerular disease, and one major cause of malignant hypertension (MHT) secondary to renal parenchymal disease. The clinical conditions and severity of renal lesion have been reported to be more serious when IgAN is accompanied by MHT, but risk factors of MHT in IgAN analyzed from Traditional Chinese Medicine (TCM) perspective are still unclear.

Objective

To explore the TCM-related factors and pathogenesis associated with MHT in IgAN patients.

Methods

From 518 cases of primary IgAN who were diagnosed by renal biopsy in First Medical Center of Chinese PLA General Hospital during December 2013 to September 2021, a sample of 12 cases accompanied by MHT (IgAN-MHT group) computed by PASS 15.0 were selected for correlation power analysis, and they were matched at a ratio of 1∶5 with other randomly selected 85 cases without MHT (IgAN group) . Clinical, pathological and TCM syndromes between the two groups were compared. Lasso regression was used to screen 93 TCM syndromes, among which those with significant associations with IgAN-MHT were identified by multivariate Logistic regression.

Results

Compared with IgAN group, IgAN-MHT group had higher prevalence of headache and dizziness or nausea and vomiting as the first clinical manifestations, and clinically diagnosed nephrotic syndrome, higher levels of baseline mean arterial pressure, highest systolic and diastolic blood pressure, blood urea nitrogen, serum creatinine, serum inorganic phosphorus, serum magnesium, and quantitatively estimated 24-hour urinary protein excretion, higher prevalence of CKD stages 3-5, blood stasis syndrome, subtypes of qi-deficiency syndromes (including mental fatigue and lack of strength, limb fatigue, tibia and leg weakness, dizziness, headache with nausea, and vomiting) , subtypes of yin-deficiency syndromes (including blurred vision and eye floaters) , subtypes of blood stasis syndromes (including nail cyanosis, and dark purple tongue) , and intrarenal arteriosclerosis (P<0.05) . Moreover, IgAN-MHT group had lower prevalence of abnormal urine test results as the first clinical manifestations, previous hypertension and clinical diagnosed chronic nephritic syndrome, as well as lower levels of mean serum IgM and IgG levels, and eGFR (P<0.05) . Both groups had no significant difference in the prevalence of interstitial fibrosis/tubular atrophy (T) lesions among the two groups (P<0.05) . The common TCM syndrome in IgAN-MHT group was qi-yin deficiency syndrome combined with blood stasis syndrome. Correlation analysis showed that IgAN-MHT was positively associated with blood stasis syndrome (P<0.05) ; in IgAN-MHT group, male and quantitatively estimated 24-hour urinary protein excretion was positively associated with qi-deficiency syndrome (P<0.05) ; serum inorganic phosphorus and potassium was negatively associated with yin-deficiency syndrome (P<0.05) , and renal tubular atrophy/interstitial fibrosis was positively associated with blood stasis syndrome (P=0.040) . Multivariate Logistic regression analysis showed that headache〔OR=7.895, 95%CI (1.643, 37.935) , P=0.010〕, blurred vision〔OR=5.499, 95%CI (1.207, 25.053) , P=0.028〕, dry mouth with desire for drink 〔OR=10.079, 95%CI (2.289, 44.373) , P=0.002〕, and nail cyanosis〔OR=18.312, 95%CI (2.179, 153.884) , P=0.007〕 were associated with MHT in IgAN.

Conclusion

IgAN-MHT patients had worse renal function and more serious renal pathological damage. The common TCM syndrome in IgAN-MHT was qi-yin deficiency syndrome with blood stasis syndrome. The clinical and pathological indices of IgAN-MHT patients had a certain level of correlation with qi-deficiency syndrome, yin-deficiency syndrome and blood stasis syndrome. The subtypes of TCM syndromes, such as headache, blurred vision, dry mouth with desire for drink, and nail cyanosis were the influencing factors of MHT in IgAN. Early detection, diagnosis and treatment, concern for and improvement of symptoms related to syndromes of qi-deficiency, yin-deficiency, and blood stasis, may contribute to decreased risk of MHT in IgAN.

Reference Range for Thyroid Function during Twin Pregnancies

Chao ZHANG, Yan LONG, Xina FU

2022, 25(27):  3404-3408.  DOI: 10.12114/j.issn.1007-9572.2022.0176

Asbtract ( )   HTML ( )   PDF (1798KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The correct reference range for maternal thyroid function during pregnancy is essential for making an accurate diagnosis of thyroid disease and delivering proper interventions in pregnant women. But there is still no universal standard for this in women with a twin pregnancy.

Objective

To determine a rational reference range for maternal thyroid function during twin pregnancies.

Methods

Healthy pregnant women who underwent antenatal examination in Obstetric Clinic, Beijing Friendship Hospital, Capital Medical University from January 2009 to September 2019 were retrospectively selected, including 352 with a twin pregnancy (twin group) , and 988 with a singleton pregnancy (singleton group) . Clinical and laboratory data were collected. The lower and upper limits for determining normal maternal thyroid function during twin pregnancies were the 2.5 (P_2.5) and 97.5 (P_97.5) percentiles of TSH and FT₄. Clinical hyperthyroidism was defined as TSH<P_{2.5 (total TSH)} and FT₄>P_{97.5 (total FT4)} . Clinical hypothyroidism was defined as TSH>P_{97.5 (total TSH)} and FT₄<P_{2.5 (total FT4)} . Subclinical hypothyroidism was diagnosed by TSH>P_97.5 and P_2.5≤FT₄≤P_97.5. Low T₄ syndrome was diagnosed by P_{2.5 (total TSH)} ≤TSH≤P_{97.5 (total TSH)} and FT₄<P_{2.5 (total FT4)} . FT₄ and TSH levels in the early, middle and late pregnancy were compared between singleton and twin groups. Prevalence of thyroid function abnormalities in the early, middle and late pregnancy was in twin group was recorded and analyzed.

Results

Three hundred and fifty-two pregnant women with a twin pregnancy and 988 with a singleton pregnancy were finally included. The average FT₄ level in the twin group was higher than that of the singleton group regardless of the stage of pregnancy (P<0.05) . The average TSH level in the twin group was lower in the early pregnancy, but was higher in late pregnancy compared with that of singleton group (P<0.05) . For maternal thyroid function during a twin pregnancy, the determined normal FT₄ in the early, middle and late pregnancy expressed as median and interquartile range M (P_2.5, P_97.5) was 〔11.84 (7.95, 26.73) 〕, 〔8.24 (5.53, 18.58) 〕, 〔8.37 (5.80, 15.79) 〕pmol/L, respectively, and the determined normal TSH in the three stages of pregnancy was〔0.67 (0.03, 3.99) 〕, 〔1.44 (0.06, 4.79) 〕, 〔2.43 (0.41, 6.92) 〕mU/L, respectively. In the twin group, the prevalence of hyperthyroidism, clinical hypothyroidism, subclinical hypothyroidism, and low T₄ syndrome was 0, 0.28% (1/352) , 4.83% (17/352) and 3.98% (14/352) , respectively, by the above-mentioned criteria for diagnosing thyroid disease in a twin pregnancy, and that of the four diseases was 8.24% (29/352) , 0, 15.91% (56/352) and 1.99% (7/352) , respectively, by the criteria for diagnosing thyroid disease in a singleton pregnancy.

Conclusion

In this study, the recommended reference ranges of FT₄ in the early, middle and late stages of pregnancy were 7.95-26.73, 5.53-18.58 and 5.80-15.79 pmol/L, respectively, and the reference ranges of TSH were 0.03-3.99, 0.06-4.79 and 0.41-6.92 mU/L, respectively. Based on the FT₄ and TSH standards of the pregnant women with twin pregnancies obtained in our laboratory as the reference standards, the incidence of thyroid dysfunction detected in the pregnant women with twin pregnancies is low, which is consistent with relevant literature reports. The FT₄ and TSH standard range of single pregnancy obtained in our laboratory may lead to overdiagnosis of hyperthyroidism and subclinical hypothyroidism in pregnant women of twin pregnancy. So it is necessary to establish specific reference intervals for pregnant women with twin pregnancies based on the FT₄ and TSH standard ranges obtained in our laboratory.

CFD Modeling of Vascular Hemodynamics in Nutcracker Syndrome

Shikun ZHANG, Lu TANG, Xiaojie XU, Yinghong ZHAO

2022, 25(27):  3409-3414.  DOI: 10.12114/j.issn.1007-9572.2022.0324

Asbtract ( )   HTML ( )   PDF (2499KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Recent research on nutcracker syndrome has focused mainly on exploring the value and criteria of various imaging modalities for the diagnosis of the disease. Providing more quantitative parameters related to the lesion through non-invasive modalities has been a focus of studies on clinical diagnosis and treatment of nutcracker syndrome. However, no relevant data are available on pressure changes in left renal vein and inferior vena cava and hemodynamic parameters in left renal due to different degrees of stenosis in the left renal vein.

Objective

To develop acomputational fluid dynamics (CFD) model to obtain the hemodynamics of individuals with nutcracker syndrome, to explore the relationship of blood flow velocity, wall static pressure, and wall shear stress with the change of vessel disease.

Methods

70 patients with nutcracker syndrome were sampled from the Affiliated Hospital of Xuzhou Medical University from September 2019 to March 2021. CFD was used to simulate the intravascular blood flow in the left renal vein of real-world patients with nutcracker syndrome based on CT enhanced images. The hemodynamic characteristics, including vascular diameter and flow velocity, were obtained and compared with those measured by ultrasound.

Results

The left renal vein's intake pressure was high, but the stenosis and exit pressures were low. From the inlet to the outlet, the pressure successively dropped. Except for the narrow region, the wall shear stress was smaller, and the closer to the center of the stenosis, the higher the shear stress. The blood flow velocity in the stenosis was significantly higher than that in other areas of the left renal vein, which was consistent with the result of ultrasonography.

Conclusion

The successfully developed vascular model, The hemodynamic change rules of nutcracker syndrome patients include that the inner diameter of the left renal vein becomes smaller and the flow velocity increases at the stenosis.

Prevalence of Acceptance of Noninvasive Positive-pressure Ventilation and Associated Factors in Hainan Adult Population with Obstructive Sleep Apnea-hypopnea Syndrome

Li DU, Xiaohua XIONG, Fangfang DUAN, Xue REN, Chunju YANG, Yiting GUAN, Peipei WANG

2022, 25(27):  3414-3421.  DOI: 10.12114/j.issn.1007-9572.2022.0317

Asbtract ( )   HTML ( )   PDF (2511KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Noninvasive positive-pressure ventilation (NPPV) is the first choice for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) , a common sleep-related breathing disorder. But low patient adherence to NPPV limits its clinical application and promotion.

Objective

To explore the situation of acceptance of NPPV and associated factors in adult OSAHS patients.

Methods

OSAHS patients (age≥18) with clinical indications for NPPV were selected from Sleep Medicine Department, Sanya Central Hospital (Hainan Third People's Hospital) , from December 2019 to December 2021. Demographic and clinical data were compared in groups defined by the acceptance of NPPV titration (acceptors and rejecters of NPPV titration) and treatment (acceptors and rejecters of NPPV) .

Results

In all, 402 OSAHS patients were included. Three hundred and twenty-seven rejected NPPV, 245 (74.5%) of them directly rejected the treatment at the time of diagnosis without NPPV titration, and the most common reason was perceived unnecessity of NPPV treatment due to insufficient understanding of OSAHS and its related risks, and 82 (25.1%) rejected the treatment after NPPV titration, and the most common reason was perceived inconvenience of long-term NPPV. Only 75 (75/402, 18.7%) patients accepted NPPV. No differences were found between acceptors and rejecters of titration in demographic data, clinical characteristics (P>0.05) . Multivariable Logistic regression analysis revealed none of above-mentioned factors were related to titration acceptance (P>0.05) . Univariable analysis showed that compared with NPPV rejecters, NPPV acceptors had higher prevalence of middle-aged (45-59 years old) individuals (49.3 % vs 33.3%) , lower prevalence of older individuals (age≥60) (12.0% vs 32.1%) , higher prevalence of nighttime awakening due to shortness of breath (38.7% vs 26.3%) , and severe condition (64.0% vs 47.4%) , lower mean nocturnal SpO₂ and nadir SpO₂, and longer mean duration with SpO₂ below 90% (T90, P<0.05) . Multivariable Logistic regression analysis revealed that age and T90 were independently associated with NPPV acceptance (P<0.05) . After controlling for other factors, age〔OR=0.39, 95%CI (0.16, 0.93) , P<0.05〕and T90〔OR=1.14, 95%CI (1.01, 1.29) , P<0.05〕were still the independently associated with NPPV acceptance.

Conclusion

The prevalence of NPPV acceptance was low in OSAHS patients, which was mainly associated with age and T90. In view of this, to improve the adherence to NPPV, relevant health education and cognitive and behavioral interventions for the patients, especially the older individuals (age≥60) , should be strengthened. Meanwhile, close attention should be paid to whole course management of NPPV in these patients.

Clinical, Interleukin-6 and Tumor Necrosis Factor-α Responses to Needling Posterior Neck Meridian Sinews Nodes and Herbal Ointment Externally Applied to Yongquan Acupoint in Patients with Post-ischemic Stroke Insomnia

Longlin YE, Yeqing WANG, Pingping JIANG, Yingxun LIN, Min HONG

2022, 25(27):  3422-3428.  DOI: 10.12114/j.issn.1007-9572.2022.0117

Asbtract ( )   HTML ( )   PDF (2652KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Against the backdrop of global aging, the onset age of ischemic stroke is getting younger and the prevalence is increasing, with insomnia as one of its complications.

Objective

To examine the clinical, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) responses to needling posterior neck meridian sinews nodes and herbal ointment externally applied to Yongquan acupoint in patients with post-ischemic stroke insomnia.

Methods

A total of 80 outpatients and inpatients with post-ischemic stroke insomnia were recruited from the First Affiliated Hospital of Guangdong Pharmaceutical University from May 2020 to May 2021, and equally divided into a Chinese medicine group (treated using needling posterior neck meridian sinews nodes and herbal ointment externally applied to Yongquan acupoint) and a Western medicine group (treated using estazolam) by complete randomization. Both groups were treated for two treatment cycles (10 times of treatment as one cycle) . Comparisons of intergroup differences were made in terms of the total score and domain scores (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction) of Pittsburgh Sleep Quality Index (PSQI) , Athens Insomnia Scale (AIS) score, and serum IL-6 and TNF-α levels at baseline, and the end of the first and second cycles of treatment, as well as overall efficacy.

Results

All patients were included for analysis except for three dropouts (one was treated with Chinese medicine and the other two with Western medicine) . The type and duration of treatment had significant interaction effects, and main effects on mean total score of PSQI and mean score of each of its domains as well as mean AIS score (P<0.05) . After the end of the first or second treatment cycle, the mean total score and domain scores of PSQI as well as mean AIS score in both groups were lower than before treatment(P<0.05). After the end of the second treatment cycle, the mean total score and domain scores of PSQI as well as mean AIS score in both groups were lower than the end of the first treatment cycle (P<0.05) . After the end of the first or second treatment cycle, the mean total score and domain scores of PSQI as well as mean AIS score in Chinese medicine group were lower than those in Western medicine group (P<0.05) . The type and duration of treatment produced significant interaction effects, and main effects on mean levels of serum IL-6 and TNF-α (P<0.05) . After the end of the second treatment cycle, the mean levels of serum IL-6 and TNF-α in both groups were lower than the end of the first treatment cycle (P<0.05) . After the end of the first or second treatment cycle, the mean levels of serum IL-6 and TNF-α in Chinese medicine group were lower than those in Western medicine group (P<0.05) . The overall clinical efficacy of Chinese medicine group was better than that of Western medicine group (Z=2.234, P<0.05) .

Conclusion

Compared to estazolam, needling posterior neck meridian sinews nodes in combination with herbal ointment externally applied to Yongquan acupoint achieved more significantly improved sleep quality and reduced serum IL-6 and TNF-α levels as well as higher overall efficacy in post-ischemic stroke insomnia patients.

Summary of Best Evidence for the Management of Noninvasive Positive Pressure Ventilation in Adults with Obstructive Sleep Apnea Hypopnea Syndrome

Qiushuang WANG, Xin AN, Xinhui SHI, Dan ZHANG, Jinghua MA

2022, 25(27):  3429-3434.  DOI: 10.12114/j.issn.1007-9572.2022.0309

Asbtract ( )   HTML ( )   PDF (2103KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Noninvasive positive pressure ventilation (NPPV) is the most common treatment for obstructive sleep apnea hypopnea syndrome (OSAHS) , which can effectively improve the hypopnea condition. At present, there are various NPPV programs with no summary of the relevant best evidence in China.

Objective

To search and evaluate studies related to NPPV management in OSAHS patients, then summarize the best evidence, to inform clinical practice.

Methods

All evidence (including guideline, expert consensus, randomized controlled trial, evidence summary, systematic evaluation and meta-analysis) on the management of NPPV in patients with OSAHS was retrieved from databases and websites including BMJ Best Practice, Up To Date, Scottish Intercollegiate Guidelines Network, Guidelines International Network, National Institute for Health and Care Excellence, National Guideline Clearinghouse, Registered Nurses' Association of Ontario, New Zealand Guidelines Group, Chinese Guideline Network, the Joanna Briggs Institute Evidence-based Health Care Center, Cochrane Library, Web of Science, Embase, PubMed, Scopus, Wanfang Data, CNKI, VIP and American Academy of Sleep Medicine from inception to December, 2021. The methodological quality of the included literature was evaluated using corresponding quality evaluation criteria. The evidence was described and summarized using JBI levels of evidenceand and JBI grades of recommendation (2014) , then the recommended strength of the evidence is determined according to the FAME scale (feasibility, appropriateness, meaningfulness and effectiveness) .

Results

A total of 10 studies were included, including 6 guidelines, 2 expert consensuses, 1 Meta-analysis and 1 randomized controlled trial. Finally, 27 pieces of best evidence were summarized, involving 8 aspects: scope of application, duration of use, mode selection, pressure regulation, efficacy evaluation, nursing intervention, follow-up and alternative treatment.

Conclusion

We summarized the best evidence involving the above-mentioned 8 aspects for NPPV management in OSAHS patients, providing an evidence-based basis for the implementation of standardized NPPV treatment.

Review

Recent Advances in the Diagnosis and Management of Multiple Primary Lung Cancer

Ziqiang HONG, Dacheng JIN, Xiangdou BAI, Baiqiang CUI, Yunjiu GOU

2022, 25(27):  3435-3442.  DOI: 10.12114/j.issn.1007-9572.2022.0331

Asbtract ( )   HTML ( )   PDF (2781KB) ( )  

Figures and Tables | References | Related Articles | Metrics

The wide application of lung CT scan and lung cancer screening significnatly improves the detection rate of multiple primary lung cancer (MPLC) , namely, lung cancer patients have two or more primaries at the same time. It is a tough problem all the time that how to distinguish between MPLC and intrapulmonary metastases (IM) . Although histological feature analysis is a good means to distinguish them in some circumstances, molecular analysis is also needed generally. Such as the application of next generation sequencing (NGS) is useful for the distinguish between MPLC and IM. For MPLC, surgery remains the main treatment modality. For inoperable MPLC, radiotherapy and local ablation are important treatments. NGS and new therapies such as targeted drug therapy and immune checkpoint inhibitors have become new altenatives for the diagnosis and treatment of MPLC. This article reviews recent advances in the diagnosis and treatment of MPLC.

Research Progress on the Effect of Exercise and Neurobiological Mechanism on Depression

Shaokun WANG, Shiqiang WANG, Yijie WANG, Zhihan XU

2022, 25(27):  3443-3451.  DOI: 10.12114/j.issn.1007-9572.2022.0273

Asbtract ( )   HTML ( )   PDF (2832KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Exercise has been confirmed by most studies to be effective in preventing and treating depression, and has become a recommended treatment by many researchers. However, previous research results on exercise interventions for depression have not been effectively integrated, and there is still a lack of uniform clinical exercise therapy guidelines across countries. In this paper, we systematically and comprehensively discussed the effects of exercise on depression, including the effects of exercise types, intensities, frequencies, and amounts of exercise on the efficacy of depression interventions in different populations, and summarized the neurobiological mechanisms involved in the development of depression as well as the antidepressant effects of exercise by sorting out relevant literature. This paper shows that in exercise interventions for depression, aerobic exercise is the most frequently chosen type of exercise, the intensity of which is usually moderate to high intensity, and the frequency and amount of exercise are recommended at high frequency and dosage. The neurobiological mechanisms of exercise resistance to depression are mainly that exercise can improve the morphological structure of central nervous system tissue, increase the levels of a series of neurotrophic factors, thereby enhancing neuronal plasticity, and improve the function of the neurosecretory system, reducing damage to brain tissue caused by neuroinflammatory responses and oxidative stress. This paper can provide a certain reference for the development and implementation of clinical exercise prescription for depression in China, and draw on the in-depth development of exercise antidepressant research.

Clinical Practice Tips

Chronic Sphenoid Sinusitis-associated Cavernous Sinus Thrombophlebitis Complicated with Internal Carotid Artery Thrombosis and Multiple Cerebral Infarction: a Case Report and Literature Review

Lipeng DONG, Jinming CHENG, Bao CHU, Zhijuan LIU, Jingru ZHAO, Litao LI

2022, 25(27):  3452-3458.  DOI: 10.12114/j.issn.1007-9572.2022.0462

Asbtract ( )   HTML ( )   PDF (3074KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Cavernous sinus thrombophlebitis (CST) is a rare disease that may be life-threatening. The overall morbidity and mortality of CST are still high although the introduction of antibiotics has greatly promoted the reduction of them, which mostly due to delayed treatment caused by misdiagnosis. CST with internal carotid artery thrombosis and multiple cerebral infarction secondary to chronic sphenoid sinusitis is rare, but it is essential to rapidly identify, diagnose and treat the disease, since it can lead to serious neurological sequelae. We encountered a patient with chronic sphenoid sinusitis-associated internal carotid artery thrombosis and multiple cerebral infarction, identified his vascular lesions using high-resolution magnetic resonance imaging, and discussed relevant diagnosis and treatment for him, his prognosis as well as the pathogenesis based on a literature review, hoping to inform clinical treatment of CST patients.