Table of Content

15 November 2022, Volume 25 Issue 32

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Editorial & Perspectives

Targeting Pericytes for Vascular Normalization as an Emerging Strategy in Remodeling Tumor Microenvironment

LAO Shen, HE Jianxing, LIANG Wenhua

2022, 25(32):  3971-3977.  DOI: 10.12114/j.issn.1007-9572.2022.0364

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Recent studies demonstrate that, the close interactions between pericytes (PCs) and various cells (such as cancer cells, stromal cells and immune cells) in tumor microenvironment (TME) can build an immunosuppressive TME to favor cancer growth and progression by modulating tumor angiogenesis and dysfunction via abnormal paracrine signaling pathways. In this review, we focused on recent advances in non-small-cell-lung-cancer to understand the regulatory role of PCs in TME and discussed the potential value of targeting PCs for inhibiting tumor angiogenesis and normalizing tumor vasculature to remodel TME, indicating that we can break through the dilemma of combined anti vascular therapy for solid tumors at this stage by targeting the normalization of tumor blood vessels of PCs. This may be a new strategy that could be used combinedly to improve chemotherapy, small molecule inhibitor targeted therapy or immune checkpoint inhibitor therapy.

Value of Neurofilament Light Chain as a Biomarker in Peripheral Neuropathy

SUN Xiaoling, HUANG Kaiwei, WAN Xinbei, WU Ying, LI Zhijun

2022, 25(32):  3977-3983.  DOI: 10.12114/j.issn.1007-9572.2022.0571

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Neurofilament light chain (NfL) has been identified as a biomarker of axonal injury in a variety of central nervous system diseases. The value of NfL as a biomarker in peripheral neuropathy has gained increasing attention. We reviewed the relationships of serum NfL with and the dynamics of axonal injury in various immune-mediated peripheral neuropathies (such as Guillain-Barre syndrome and chronic inflammatory demyelinating polyradiculoneuropathy), hereditary peripheral neuropathy, drug-induced peripheral neuropathies and diabetic peripheral neuropathy, and drew a conclusion after a comprehensive analysis: the quantified NfL may be used as a promising biomarker to monitor disease activity, assess short- and long-term prognosis, and also as a potential biomarker for clinical trials and monitoring treatment response.

Guideline·Evidence

Evidence Summary for Management of Nail Diseases in Patients with Diabetes

CHEN Huan, HOU Chaoming, GAO Jing, BAI Dingxi, WU Chenxi, WANG Hao, YOU Qian, XIAN Yuanyuan

2022, 25(32):  3984-3990.  DOI: 10.12114/j.issn.1007-9572.2022.0362

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Background

Timely identification and proper treatment of nail disease is of great significance to the prevention of foot ulcer in diabetes. However, insufficient understanding of nail disease is highly prevalent in clinical workers. What's more, there is a lack of a summary of the best evidence about clinical management of nail diseases in diabetes in China.

Objective

To comprehensively retrieve and analyze evidence about the management of nail disease in diabetes, and give a summary of the best evidence.

Methods

We searched databases of BMJ Best Practice, UpToDate, WHO, Guidelines International Network, NICE, National Guideline Clearinghouse, RNAO, Scottish Intercollegiate Guidelines Network, New Zealand Guidelines Group, Yimaitong, JBI, PubMed, Embase, CINAHL, CNKI and Wanfang Data for clinical decisions, guidelines, systematic reviews and expert consensuses regarding the management of nail diseases in diabetes included as of December 6, 2021. Then we evaluated the quality of the evidence, and rated it according to the 2016 Supporting Document for the Joanna Briggs Institute Levels of Evidence and Grades of Recommendation, and summarized the best evidence.

Results

A total of 8 studies were enrolled, including 1 about clinical decisions, 4 guidelines and 3 expert consensuses. The clinical decisions was from the UpToDate and directly included. Two guidelines were rated B, and the other 2 were rated A, all of which were allowed to be included. All the expert consensuses showed a high level of quality, and were allowed to be included. Finally, 9 items of best evidence regarding nail disease assessment, handling and health education were summarized, including 5 A-level recommendations and 4 B-level recommendations.

Conclusion

This study searched the clinical decisions, guidelines and expert consensus related to the management of patients with diabetes mellitus, and summarized the best evidence of the management of patients with diabetes mellitus. The evidence involves three aspects: nail disease assessment, handling and health education were summarized, and the levels were A-level recommendation and B-level recommendation. Our summary of the best evidence could be used as evidence-based basis for early clinical assessment and treatment of nail disease in diabetes.

Selection and Application of Wound Dressings in Diabetic Foot Disease: Recommendations from Evidence-based Guidelines

LUO Yixin, YANG Chuan, LIU Xingzhou, MAI Lifang, WEI Xiaocui, JIANG Zhuyi

2022, 25(32):  3990-3998.  DOI: 10.12114/j.issn.1007-9572.2022.0389

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Background

Local wound management is a key part in the management of diabetic foot ulcers (DFUs), and dressings are one major tool. There are no specific guidelines on dressing selection for DFUs, and it is urgently needed to integrate relevant contents scattered in major comprehensive guidelines.

Objective

Practice guidelines related to the management of diabetic foot were searched and reviewed, and entries related to dressing selection or application were extracted for evidence synthesis to inform clinical interventions.

Methods

Published clinical practice guidelines about diabetes management were searched from diabetes websites and electronic literature databases, the search period was from January 2012 to November 2021, and screened according to inclusion and exclusion criteria, then their methodological quality was evaluated, and evidence related to dressing selection and application in which was translated, extracted and synthesized.

Results

Ten guidelines published between 2012 and 2020 were included, with overall high quality and high consistency between reviewers. Then a table of recommendations for selection and application of wound dressings for diabetic foot disease was developed by comprehensively summarizing relevant evidence extracted from the guidelines (evidence from eight guidelines in foreign languages was first translated into Chinese before being extracted) .

Conclusion

The evidence selected from the guidelines involves wound characteristics, moisture healing, periwound skin management, patient preference, and cost. Among them, wound characteristics should be seriously considered in the selection of dressings for DFUs. Most of the recommendations are about the treatment of wound exudate condition and the presence or absence of infection. However, there are fewer recommendations for basal tissue types, especially gangrene wounds.

Expert Insight of General Practice

2022 Annual Meeting of General Practitioners Association of Shanghai Medical Doctor Association (Ⅱ)

2022, 25(32):  3999-4009.  DOI: 10.12114/j.issn.1007-9572.2022.L0001

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The content of this article came from "the Second Shanghai General Practitioners (GPs) Forum" hosted by Shanghai Physicians Association, General Practitioners Division of Shanghai Physicians Association, Shanghai, China, on July 22, 2022. It was mainly proposed to improve the quality of primary medical services through different measures and channels. FENG Dianxu reported that through systematic improvement and 3 convenient work, the clinical quality control management of general practice was strengthened. YI Chuntao reported that discipline construction can lay a good foundation for improving the quality of community health services, provide a high-quality platform for talent echelon construction, and is an effective way to continuously promote the development of community health. XIAO Feng reported that the prevalence of atrial fibrillation has risen sharply with age, while the standardized management mode of the community has not yet been formed. By relying on the "three platforms", strengthening the "three constructions" and improving the "three processes", the influence of the grassroots on specialized diseases can be dredged. TANG Lan reported that through graded diagnosis and treatment, the combination of full-time and specialized nursing was strengthened, and the professional nursing ability of specialized nurses in grass-roots communities was improved. WU Yumiao reported that through the construction of standard hospice care services of "two satisfaction", "three stages" and "five completion", the happiness index of residents was improved. WEI Wei reported that by building a "home gate" rehabilitation intelligent service platform for residents, it will provide various forms of comprehensive, intelligent and comprehensive rehabilitation services.

Article

Predictive Value of Gait Speed and Grip Strength for All-cause Mortality and Falls in Geriatric Inpatients

YANG Hui, CUI Yunjing, ZHANG Shaojing, WANG Lijun, WANG Qing

2022, 25(32):  4010-4017.  DOI: 10.12114/j.issn.1007-9572.2022.0355

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Background

Gait speed and grip strength are simple markers of physical capability, which are associated with adverse outcomes in the elderly. However, there are few studies on the prediction of adverse outcomes in this population by the combination of the two markers.

Objective

To investigate the associations of gait speed and grip strength with adverse outcomes in geriatric inpatients.

Methods

A cohort design was used in this study. From August 2015 to December 2018, eligible geriatric inpatients aged≥65 years were recruited from Department of Geriatrics, Fuxing Hospital, Capital Medical University. We measured the gait speed and grip strength with 6-meter walking test and dynamometer, respectively. By the gait speed, the patients were divided into tertiles (T1 group: ≤ 0.6 m/s, T2 group: >0.6-0.8 m/s, T3 group: >0.8 m/s). By the grip strength, they were divided into L1, L2 and L3 tertiles (L1 group: ≤ 21.6 kg for males, ≤ 14.6 kg for females; L2 group: > 21.6 kg but ≤ 28.2 kg for males, >14.6 kg but ≤ 19.4 kg for females; L3 group: >28.2 kg for males, >19.4 kg for females). Follow-up was conducted by telephone once every three months within one year after discharge and once half a year after this until December 31, 2019. All-cause mortality and falls were recorded. Survival curves were constructed by the Kaplan-Meier method. Cox regression analysis was used to investigate the association of gait speed, grip strength, or their combination with all-cause mortality and falls. ROC curves for comparing the ability of the two makers or their combination on predicting all-cause mortality and falls.

Results

Among the 685 patients, 29 (4.2%) were lost to follow-up, and the other 656 cases who finished the follow-up with complete data were included for analysis. During the follow-up period, 130 patients (19.8%) died from all causes and 147 patients (22.4%) experienced falls. There were 222, 225 and 209 patients in the low, moderate and high tertiles of gait speed (T1, T2 and T3 groups), and 215, 229 and 212 patients in the low, moderate and high tertiles of grip strength (L1, L2 and L3 groups), respectively. Log-rank test showed that the cumulative survival curves of all-cause mortality and falls differed significantly among T1, T2 and T3 groups (P<0.01). The same results were obtained in L1, L2 and L3 groups (P≤0.01). Cox regression analysis with adjustment for potential confounders showed that compared to patients in high tertiles of both gait speed and grip strength, the risk of all-cause mortality significantly increased in those both in low gait speed and low or moderate tertiles grip strength〔HR=3.29, 95%CI (1.13, 9.55) ; HR=3.09, 95%CI (1.08, 8.85) ; P<0.05〕, and the risk of fall significantly increased in those in low tertiles of both gait speed and grip strength 〔HR=1.92, 95%CI (1.13, 4.27), P<0.05〕. The prediction probability of the joint diagnostic model of gait speed and grip strength was estimated by Logistic regression analysis, and the AUC of the combination of them for predicting all-cause mortality and falls was 0.756 〔95%CI (0.710, 0.801) 〕, and 0.700〔95%CI (0.659, 0.741) 〕, respectively.

Conclusion

In geriatric inpatients, the combination of gait speed and grip strength had higher predictive value for all-cause mortality and falls, which is helpful to optimize the health management.

Correlation of Markers of Inflammation and Endothelial Injury with Thrombosis in Left Atrium in Patients with Atria Fibrillation

LI Jinyi, LIANG Guicheng, WANG Shirong, LI Shuhu, KE Honghong

2022, 25(32):  4018-4022.  DOI: 10.12114/j.issn.1007-9572.2022.0490

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Background

Atrial fibrillation (AF) patients are prone to stroke and peripheral arterial embolism. Studying the pathogenesis of thrombosis formation in AF and providing effective interventions to reduce the risk is an important direction of clinical and basic research on AF.

Objective

To investigate the correlation of markers of inflammation and endothelial injury with thrombosis in the left atrium (LA) in AF patients.

Methods

Twenty-nine patients with valvular heart disease and 10 patients with coronary heart disease who underwent thoracotomy at the First Affiliated Hospital of Guangxi Medical University from July 2017 to December 2019 were selected, and divided into sinus rhythm group (15 cases) and AF group 〔24 cases, including 12 with left atrial appendage thrombus (LAAT), and 12 without LAAT〕 according to heart rhythm. General demographics were collected. Besides that, other data were also collected, including left atrial diameter (LAD) and left ventricular ejection fraction (LVEF), levels of protein kinase B (AKT), nuclear factor-κ B (NF-κ B), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), IL-8, tumor necrosis factor (TNF-α), endothelin-1 (ET-1), nitric oxide (NO), von Willebrand factor (VWF), intercellular adhesion molecule (ICAM-1) and vascular cell adhesion factor (VCAM-1) in the left atrial blood sample, and calculated thrombus area in patients with AF and LAAT. The relationships of LAD, LVEF, markers of inflammation and endothelial injury with calculated area of thrombus in AF with LAAT patients were analyzed by Pearson correlation.

Results

There were significant differences in LAD and LVEF between sinus rhythm patients and AF patients with or without LAAT (P<0.05). AF patients with and without LAAT had no significant differences in LAD and LVEF (P>0.05). AF patients without LAAT had higher levels of AKT, NF-κB, IL-8, ET-1, ICAM-1 and VCAM-1 and lower NO level in left atrium than patients with sinus rhythm (P<0.05). AF patients with LAAT had higher levels of AKT and hs-CRP, and lower NO level in left atrium than those without (P<0.05). AF patients with and without LAAT had no significant differences in levels of NF-κB, IL-6, IL-8, TNF-α, ET-1, vWF, ICAM-1 and VCAM-1 (P>0.05). The maximum area, minimum area, and average area of the left atrial appendage thrombus in AF patients with LAAT were 4.8 cm², 1.67 cm², and (3.48±0.83) cm², respectively. Pearson correlation analysis showed LAD, LVEF, AKT, NF-κB, hs-CRP, IL-6, IL-8, TNF-α, ET-1, NO, vWF, ICAM-1, and VCAM-1 had no linear correlation with the area of thrombus in AF patients with LAAT (P>0.05) .

Conclusion

Increased levels of markers of inflammation and endothelial injury in left atrium were found in AF patients, which were even more higher when the patients also had LAAT. Detecting the markers of inflammation and endothelial injury in left atrium is helpful to evaluate the thrombus prevalence in AF patients.

Clinical Observation of the Effectiveness of Methadone in Refractory Carcinous Pain Patients

ZHOU Qinfei, GONG Liyan

2022, 25(32):  4023-4028.  DOI: 10.12114/j.issn.1007-9572.2022.0526

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Background

As a strong opioid, methadone has unique advantages in relieving refractory carcinous pain, but also has some limitations, such as higher risk of accumulation due to long elimination half-life, difficulties in dosage calculation and dose conversion due to significant differences between individuals, and limited clinical evidence on the use of this medicine in large doses.

Objective

To investigate the efficacy and safety of methadone conversion in patients with refractory carcinous pain.

Methods

A total of 100 inpatients with refractory carcinous pain were recruited from Cancer Hospital of the University of Chinese Academy of Sciences/Zhejiang Cancer Hospital from July 2017 to December 2021. The conversion of morphine to methadone was carried out by rapid conversion or 3-day conversion method. The doses of methadone used at one week and two weeks after the conversion, the daily mean pain intensity assessed by the Numeric Rating Scale (NRS), number of breakthrough pain and adverse reactions before and after methadone conversion were recorded. The efficacy and safety of methadone conversion were analyzed.

Results

There was a dynamic conversion ratio between morphine and methadone. The conversion ratio between morphine and methadone increased with the growth of the daily dose of morphine. Ninety-six cases finally completed methadone conversion. The mean NRS score and the number of breakthrough pain were significantly reduced at one week or two weeks after the conversion (P<0.05). The rate of the most severe pain relief and the rate of average pain relief were 68.8% and 75.0%, respectively, at one week after methadone conversion, and were 69.8%, and 77.1% respectively, at two weeks after methadone conversion. The main adverse reactions to methadone included dry mouth, nausea, vomiting, constipation, dizziness and cold sweat. Compared with before conversion, the incidence of nausea (χ² _pair =7.005, 8.233) and vomiting (χ² _pair =5.581, 10.907) were decreased at one week and two weeks after conversion (P<0.05) .

Conclusion

This study confirmed through clinical practice that methadone can reduce the mean NRS score and the number of breakthrough pain in patients with refractory cancer pain, relieve the pain intensity of patients to a certain extent, and reduce the incidence of some adverse reactions.

Association of Inter-arm Systolic Blood Pressure Difference with Arterial Stiffness among Patients with Essential Hypertension

YAN Jiafu, ZHENG Keyang, LIU Rufei, ZENG Rong, LIU Aoya, CHENG Wenli

2022, 25(32):  4029-4035.  DOI: 10.12114/j.issn.1007-9572.2022.0348

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Background

Inter-arm systolic blood pressure difference (IASBPD) is associated with an increased risk of cardiovascular events, which may be involved with arterial stiffness.

Objective

To investigate the association of IASBPD with arterial stiffness in essential hypertension.

Methods

This retrospective study consecutively included 6 834 patients with essential hypertension who were admitted to Beijing Anzhen Hospital, Capital Medical University from December 2019 to September 2021. The patients were divided into three groups according to IASBPD. Arterial stiffness was assessed by the value of brachial-ankle pulse wave velocity (baPWV). Multiple linear regression and multivariate Logistic regression models were used to analyze the association of arterial stiffness with IASBPD, then based on this, multivariate Logistic regression was further used for subgroup analysis to explore the impact of each influencing factor and their interaction on arterial stiffness.

Results

The IASBPD tertile groups were: IASBPD<5 mm Hg (n=4 248), 5 mm Hg≤IASBPD<10 mm Hg (n=1 806) and IASBPD≥10 mm Hg (n=780) .The median baPWV was 1 572 (1 392, 1 702) cm/s. The prevalence of arterial stiffness (defined as baPWV>1 800 cm/s) was 15.26% (1 043/6 834). Multiple linear regression analysis showed that IASBPD was associated with baPWV, and an increase in IASBPD by 1 mm Hg corresponded to an increase of 4.31 cm/s in baPWV〔B=4.31, 95%CI (3.29, 5.31), P<0.05〕. Multivariate Logistic regression analysis demonstrated that IASBPD≥10 mm Hg was associated with increased risk of arterial stiffness〔OR=2.28, 95%CI (1.76, 2.94), P<0.05〕, and the risk was much higher in those with LDL-C≥3.4 mmol/L (P=0.021) indicated by further subgroup analysis.

Conclusion

IASBPD≥10 mm Hg was a risk factor of arterial stiffness among essential hypertensive patients, especially in those with LDL-C≥3.4 mmol/L. IASBPD might be used as a simple and effective predictor of arterial stiffness.

Association of Nasal Obstruction with Pulmonary Function and Airway Resistance during Tidal Breathing in Infants with Wheezing

SHEN Beilan, GAO Yi, CHEN Dehui, ZHENG Jinping

2022, 25(32):  4035-4040.  DOI: 10.12114/j.issn.1007-9572.2022.0435

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Background

Measurement of lung function during tidal breathing is an important method in the diagnosis, management and severity assessment for infants with respiratory diseases. Nasal obstruction is a common comorbidity of respiratory tract infections, and severe nasal obstructionmay affect the results of pulmonary function test.

Objective

To assess the association of nasal obstruction with pulmonary function and airway resistance during tidal breathing, and to evaluate the effect of normal saline nasal drops on relieving nasal congestion and improving pulmonary function in infants with wheezing.

Methods

A total of 55 children with wheezing were included, including wheezing with nasal congestion in 25 cases and wheezing without nasal congestion in 30 cases. Fifty-five infants with wheezing as the chief symptom who were treated in the First Affiliated Hospital of Guangzhou Medical University were retrospectively selected from June 2015 to May 2016. They received the measurement of pulmonary function during tidal breathing, respiratory resistance using the respiratory resistance tester with single-breath method and body plethysmography. Nasal obstruction was assessed, and those with three points were excluded, the remaining infants with 0 and 1-2 points were assigned to wheezing without nasal obstruction group (n=30), wheezing with nasal obstruction group (n=25), respectively. Baseline lung functions were compared between wheezing with nasal obstruction group before nasal obstruction treatment and without nasal obstruction group. And pulmonary functions of wheezing with nasal obstruction group were compared before and after nasal obstruction treatment.

Results

Wheezing infants with nasal obstruction had higher specific effective airway resistance (sReff) and effective airway resistance (Reff) than those without (P<0.05). The ratio of the proportion of time to reach peak tidal expiratory flow to total expiratory time (TPTEF/TE) 〔 (24.58±6.15) % vs. (21.12±4.16) %〕and the ratio of the volume until peak expiratory flow to the total expiratory volume (VPEF/VE) 〔 (26.38±5.19) % vs. (22.98±3.75) %〕 improved significantly in wheezing infants with nasal obstruction after nasal obstruction was relieved by treatment compared to the baseline (P<0.05). The respiratory resistance (RrsSO), sReff and Reff decreased significantly in wheezing infants with nasal obstruction after nasal obstruction was relieved compared to the baseline (P<0.05) .

Conclusion

Nasal obstruction could increase the airway resistance (sReff and Reff) in wheezing infants. Pre-test nasal secretion clearance is one criterion in quality control of pulmonary function tests. Nasal obstruction caused by secretions could be effectively relieved by liquefying the secretions with a few drops of normal saline. The tidal breathing parameters (TPTEF/TE and VPEF/VE ratios) and airway resistance parameters (RrsSO, sReff and Reff) were improved after nasal obstruction was relieved.

Abnormal Change of Serum Irisin Level in Overweight or Obese Patients with Type 2 Diabetes Mellitus

ZHANG Nan, JIANG Tian, ZHANG Yi, ZHANG Qiu

2022, 25(32):  4041-4045.  DOI: 10.12114/j.issn.1007-9572.2022.0491

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Background

Obesity may cause insulin resistance (IR), then leads to type 2 diabetes mellitus (T2DM), seriously affecting human health. Irisin is a newly discovered myokine produced by adipose and skeletal muscle tissues, which plays an important role in metabolic regulation. It is worth investigating what changes will occur in serum irisin levels in T2DM patients with overweight or obesity.

Objective

To examine the abnormality in serum irisin levels in overweight or obese patients with T2DM, and to explore the influencing factors.

Methods

A total of 119 patients with T2DM who were hospitalized in Department of Endocrinology, the First Affiliated Hospital of Anhui Medical University from December 2019 to June 2021 were selected, including 78 with overweight or obesity and 41 with normal weight assessed by body mass index (BMI). They were compared to 52 healthy people with normal body weight in terms of general demographics, laboratory test indices and serum irisin level. Spearman rank correlation analysis was used to explore the correlation of serum irisin level with demographic and laboratory test indices. Multiple linear regression analysis was used to explore factors associated with the abnormality in serum irisin in overweight or obese T2DM patients.

Results

Normal-weight diabetics, overweight or obese diabetics and healthy controls had significant differences in levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), BMI, triacylglycerol (TG), high-density lipoprotein cholesterol (HDL-C), glycosylated hemoglobin (HbA_1c), fasting blood glucose (FBG), fasting insulin (FINS) and homeostasis model assessment of insulin resistance (HOMA-IR) (P<0.05). The serum irisin level in normal-weight diabetics was lower than that in healthy controls (P<0.05). Overweight or obese diabetics had lower serum irisin level than healthy controls or normal-weight diabetics (P<0.05). Spearman rank correlation analysis showed that serum irisin level was positively correlated with HDL-C (r_s=0.304, P<0.05), and negatively correlated with SBP, DBP, BMI, TG, HbA_1c, FBG, FINS, and HOMA-IR (r_s=-0.271, -0.420, -0.372, -0.164, -0.418, -0.348, -0.293, -0.348, P<0.05). Multiple linear regression analysis showed that DBP 〔b=-0.049, P=0.011〕, HbA_1c〔b=-0.156, P=0.009〕, and FINS〔b=-0.21, P=0.038〕 were associated with the abnormality in serum irisin in overweight or obese T2DM patients.

Conclusion

T2DM patients, especially those who were overweight or obese, were found with lower serum irisin level, which was associated with BMI, blood pressure, blood lipids, blood glucose and IR.

Relationship between Androgen and Glucose Metabolism in Patients with Polycystic Ovary Syndrome

WENG Ruiwen, LIU Yi, ZHANG Wei, LIU Hengwei

2022, 25(32):  4046-4051.  DOI: 10.12114/j.issn.1007-9572.2022.0633

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Background

Hyperandrogenemia is one of the most important clinical features of polycystic ovary syndrome (PCOS) and is closely related to metabolic syndrome. The related researches evaluating the relationship between androgen and type 2 diabetes mellitus and insulin resistance were not enough, and their results were inconsistent, thus not forming an unified scientific conclusion.

Objective

To investigate the changes of androgen level in PCOS patients with different glucose tolerance, and the relationship between androgen and glucose metabolism.

Methods

This study selected 954 PCOS patients in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from March 2018 to December 2020, and collected data about androgen, 75 g glucose tolerance test and insulin release test. Body mass index (BMI), free androgen index (FAI) and homeostasis model insulin resistance index (HOMA-IR) were calculated. These patients were divided into normal glucose tolerance group (NGT), prediabetes group (IGT) and type 2 diabetes group (T2DM) according to the glucose tolerance status. PCOS patients were divided into Q1-Q4 subgroups based on the FAI quartile from low to high. PCOS patients were divided into normal (BMI<24.0 kg/m²), overweight (24.0 kg/m²≤BMI<28.0 kg/m²) and obesity subgroup (BMI≥28.0 kg/m²) according to BMI. This study compared the changes of androgen level, and the effects of androgen level on glucose metabolism in PCOS patients with different glucose tolerance, and analyzed the effect of androgen on insulin resistance.

Results

There were 490 patients in NGT group, 369 patients in IGT group and 95 patients in T2DM group. There were significant differences in BMI, FT, SHBG and FAI among these three groups (P< 0.01). Multiple linear regression analysis showed that T was a factor that affects Glu 30 min (β=0.068, P=0.037), Ins (β=0.098, P=0.002), HOMA-IR (β=0.086, P=0.008). SHBG and FAI were the factors that affect Glu 0 min, Glu 30 min, Glu 60 min, Glu 120 min, Glu 180 min, HbA_1c (β=-0.187, 0.277, P< 0.001), INS (β=-0.226, 0.371, P<0.001), HOMA-IR (β=-0.224, 0.377, P<0.001). The levels of Ins 0 min, Ins 30 min, Ins 60 min, Ins 120 min, Ins 180 min and HOMA-IR of subgroup Q1-Q3 were significantly lower than that of subgroup Q4 (P< 0.05). FT (β=0.119, P=0.031) and SHBG (β=-0.155, P=0.005) were the factors that affect HOMA-IRin patients with normal weight. SHBG (β=-0.199, P<0.001) and FAI (β=0.249, P<0.001) were the factors that affect HOMA-IR in overweight patients. T, A, FT, SHBG and FAI are the factors that affect HOMA-IR (β=0.154, 0.132, 0.291, -0.176, 0.390, P<0.05) in obese patients.

Conclusions

T, SHBG and FAI had the impact on abnormal glucose metabolism in PCOS patients, and FAI had a more significant effect. High FAI increased insulin secretion. For PCOS women with different weight, the impact of androgens on HOMA-IR were different. Clinicians should provide the personalized glucose-lowering and androgen-lowering strategy to reduce the rates of related complications based on these factors.

Distribution Pattern of Dynamic Plantar Pressure in Patients with Traumatic Extension Knee Contracture

XIONG Bin, ZHOU Yun, WANG Hua, ZHANG Quanbing, LIU Yi, LI Kai, ZHENG Haoran, WANG Jing, WANG Qunan

2022, 25(32):  4052-4058.  DOI: 10.12114/j.issn.1007-9572.2022.0546

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Background

Traumatic extensor knee contracture is very common in clinic, and most patients have gait abnormalities. In clinical rehabilitation, the assessment of gait is mostly performed using scales and balance instruments. Dynamic plantar pressure test, as a scientific and objective assessment method, has been widely used in the assessment of lower limb diseases. The use of dynamic plantar pressure test in patients with traumatic extensor knee contracture is less common both nationally and internationally.

Objective

To investigate the distribution pattern of dynamic plantar pressure in patients with traumatic extensor knee contracture, and to provide data support for guiding rehabilitation assessment and gait training.

Methods

From December 2020 to December 2021, 35 patients with traumatic extensor knee contracture who were treated in the Department of Rehabilitation Medicine of the Second Affiliated Hospital of Anhui Medical University were selected as the study group, and 30 healthy individuals with normal gait who volunteered to participate in this study during the same period were selected as the control group. ByGait-G6060-5 gait analysis system measuring instrument was used to collect the plantar pressure parameters of the two groups of subjects. The step length, step width, step speed, foot angle, total touchdown time, the proportion of plantar pressure in each area〔hallux toe (T1 area), second to fifth toe (T2 area), first metatarsal (M1 area), second metatarsal (M2 area), third metatarsal (M3 area), fourth metatarsal (M4 area), fifth metatarsal (M5 area), middle plantar (MF area), medial heel (MH area), lateral heel (LH area) 〕, the total plantar pressure Ad value, the maximum deviation distance (COP-X deviation) of plantar pressure center in the lateral (left-right body direction) and the maximum deviation distance (COP-Y deviation) of plantar pressure center in the longitudinal (anterior-posterior body direction) of the two groups were compared and analyzed.

Results

The step length of the study group was shorter than that of the control group, the step width and total touchdown time were longer than those of the control group, the step speed was slower than that of the control group, and the foot angle was higher than that of the control group (P<0.05). The proportions of plantar pressure in T2, M4 and M5 areas in the study group were higher than those in the control group, and the proportions of plantar pressure in MH and LH areas were lower than those in the control group (P<0.05). The total pressure Ad value on the affected side was lower than that on the healthy side in the study group (P<0.01). The difference was not statistically significant when comparing the percentage of total pressure Ad values on the left side with the right side in the control group (P>0.05). The deviation values in both the COP-X direction and COP-Y direction were higher in the study group than in the control group (P<0.05) .

Conclusion

The patients with traumatic extensor knee contracture have short stride length, wide based gait, slow pace, large foot angle and long total touchdown time of both feet, less weight-bearing of the affected side of the lower extremity during walking, and predominantly weight-bearing of the forefoot and lateral edge of the foot, with a greater lateral and longitudinal displacement of center of pressure trajectories across both feet, large sloshing and poor stability during walking.

Article·Focus on Special Population·Adolescents

Rehabilitative Effects of Schroth Therapy with Bonesetting Massage for Adolescent Idiopathic Scoliosis

LU Yuelun, LUO Guogang, XIE Haifeng, DAI Ziyi

2022, 25(32):  4059-4064.  DOI: 10.12114/j.issn.1007-9572.2022.0386

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Background

Adolescent idiopathic scoliosis (AIS) is becoming increasingly common in clinical settings, imposing a heavy burden on the family and society. At present, few treatments are available with fair effects for AIS, and there is a lack of unified and effective treatment schemes for AIS.

Objective

To explore the effect of Schroth therapy with bonesetting massage in AIS.

Methods

Forty adolescent AIS patients treated in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from September 2018 to December 2020 were selected, and equally randomly divided into treatment group and control group, 20 cases in each group. Both groups received bone setting massage once a week, and the treatment group additionally received Schroth therapy, 90 minutes per time, 3 times per week. The treatment for both groups lasted for 6 months. Pre- and post-treatment Cobb angle and angle of trunk rotation (ATR) as well as clinical efficacy were compared between the two groups.

Results

The Cobb angle after treatment was smaller than that before treatment in both groups (P<0.05). And the treatment group had a smaller post-treatment Cobb angle than the control group (P<0.05). ATR decreased after treatment in both groups (P<0.05), and it decreased more obviously in the treatment group (P<0.05). The response rate for either control group or treatment group was 95.0% (19/20) but the marked response rate was higher in the treatment group〔85.0% (17/20) vs. 30.0% (6/20) 〕 (P<0.001) .

Conclusion

Compared with bonesetting massage alone, Schroth therapy with bonesetting massage had better effect on improving the Cobb angle and ATR in AIS patients, so the combination therapy is recommended for clinical use.

Efficacy of Remote Rehabilitation Combined with Outpatient Treatment in Mild Adolescent Idiopathic Scoliosis

DONG Jiaxing, WANG Liancheng, ZHANG Jinchai, WANG Shuai, ZHANG Yajie

2022, 25(32):  4065-4071.  DOI: 10.12114/j.issn.1007-9572.2022.0418

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Background

Scoliosis is a common abnormal curvature of the spine. Patients with mild scoliosis are usually treated with outpatient physiotherapy, but satisfactory efficacy is associated with appropriate treatment time and frequency. The efficacy of offline physiotherapy may be affected by limited medical resources and patients' treatment time and geographical location. Remote rehabilitation may save patients' treatment time and increase the geographical accessibility of physiotherapy, making the therapy more simple and convenient.

Objective

To explore the efficacy of remote rehabilitation combined with outpatient treatment in mild adolescent idiopathic scoliosis (AIS) .

Methods

Fifty-eight eligible mild AIS patients were selected from Department of Rehabilitation Medicine, Tianjin Hospital from September 2020 to September 2021, and divided into three groups according to patients and their parents' selection of treatment: online group (n=18), combined group (n=20) and offline group (n=20). The online group received WeChat- and Tencent Video-based physiotherapeutic scoliosis specific exercise (PSSE), the combined group received both outpatient and WeChat- and Tencent Video-based PSSE treatment, and the offline group received outpatient PSSE treatment. Data of three groups were collected, including the main curve Cobb angle, coronal balance (CB), thoracic kyphosis (TK) angle, lumbar lordosis (LL) angle, sagittal vertical axis (SVA), angle of axial trunk rotation (ATR), parietal vertebra rotation (Raimondi), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), muscle activation rate (MAR) on both sides of paraspinal vertebrae, root mean square ratio (RMSR) of paraspinal muscles on both sides of paraspinal vertebrae, and the score of SRS-22 before and after treatment.

Results

The main curve Cobb angle, TK, SVA, ATR, Raimondi, SS, MAR on paraspinal vertebrae, RMSR on the concave side of the parietal vertebra and SRS-22 self-image and mental health domain scores were significantly different from those before treatment in all groups (P<0.05). Specifically, the combined group was superior to the other two groups in improved ATR and treatment satisfaction. The combined group had significantly improved main curve Cobb angle after treatment than the online group. The improvement of the concave MAR in either the combined group or offline group was significantly better than that in the online group (P<0.05) .

Conclusion

In mild AIS patients, remote rehabilitation combined with outpatient treatment could effectively slow down the progression of AIS curve, improve sagittal abnormality of spine, abnormal posture and vertebral rotation, increase the activation rate of paraspinal muscles on the concave side of paraspinal vertebra and improve the balance of paraspinal muscles on both sides of paraspinal vertebrae. Moreover, the combined therapy also improved the quality of life.

Article·Epidemiologic Research

Death Status and Trends of Female Mental Disorders Patients in Pudong New Area of Shanghai, 2005-2021

SHEN Dingyi, LI Xiaopan, MENG Fanping, LU Jingjue, ZHOU Yixin, LYU Jun

2022, 25(32):  4072-4078.  DOI: 10.12114/j.issn.1007-9572.2022.0290-1

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Background

There are few epidemiological analyses on mental illness deaths among Chinese residents. As an economically developed region, Shanghai has more complete health information system, which can provide data support for deeper analysis of smaller categorical disease characteristics and causes of death among residents, and analysis of the circumstances and trends of deaths related to mental disorders among women in Shanghai will help to understand the local burden of mental disorders in women.

Objective

To analyze the death status and trend of mental disorders among female residents in Pudong New Area of Shanghai from 2005 to 2021.

Methods

Cause of death monitoring data of registered residents of the whole population in Pudong New Area from 2005 to 2021 were collated, and deaths of local female residents with mental disorders were analyzed by using indicators such as crude mortality rate, standardized mortality rate, years of life loss and rate of life loss, and annual percentage change (APC) and average annual percentage change (AAPC) were calculated by using Joinpont regression model for trend analysis.

Results

From 2005 to 2021, there were 1 165 female deaths from mental disorders in Pudong New Area of Shanghai, accounting for 0.32% of the total deaths in the same period. The crude mortality rate was 4.82/100 000, and the standardized mortality rate was 1.85/100 000. The crude mortality rate of female mental disorders in Pudong New Area of Shanghai showed a downward trend from 2005 to 2012 (APC=-13.05%, P=0.002), and an upward trend from 2012 to 2021 (APC=7.66%, P=0.012). The standardized mortality rate showed a downward trend from 2005 to 2012 (APC=-16.79%, P<0.001), and a overall downward trend from 2005 to 2021 (AAPC=-4.93%, P=0.009). The life loss rate showed a downward trend from 2005 to 2012 (APC=-13.79%, P<0.001), and an upward trend from 2012 to 2021 (APC=6.93%, P=0.011). From 2005 to 2021, the death age of female mental disorders in Pudong New Area of Shanghai was 50.8-105.8 years old, and the death age distribution was dominated by ≥80 years old (79.48%), and the death rate of female mental disorders ≥80 years old showed an overall upward trend (AAPC=0.98%, P=0.027). From 2005 to 2021, the proportion of women who died at aged 70-79 with mental disorders was 16.57%. The death rate (AAPC=-5.13%, P=0.026), crude mortality rate (AAPC=-7.20%, P=0.003) and life loss rate (AAPC=-6.89%, P=0.005) showed a downward trend as a whole.

Conclusion

From 2005 to 2021, the standardized mortality rate of female mental disorders in Pudong New Area of Shanghai showed a downward trend as a whole, but the death rate of female mental disorders≥80 years old showed an overall upward trend. The burden of mental disorders among elderly female residents deserves attention of local authorities. Promoting the mental health of elderly women is conducive to improving the health level of local women.

Cancer Incidence Trend in Chinese Longevity Town Cenxi City from 2016 to 2020

WU Fanying, LYU Wu, DU Kun, ZHOU Jingfan, HUANG Guolin, FENG Jie

2022, 25(32):  4079-4084.  DOI: 10.12114/j.issn.1007-9572.2022.0352

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Background

Along with the acceleration of population aging and the increase in average life expectancy, how to improve the quality of life of residents has become a social focus. Cancer is a major factor that seriously affects the health, causing increased medical burden. Therefore, it is of great significance to analyze cancer incidence in Cenxi City, Guangxi.

Objective

To perform a statistical analysis of cancer incidence in Cenxi from 2016 to 2020.

Methods

Data on cancer incidence in Cenxi from 2016 to 2020 were obtained from the Cancer Registry System of Cenxi Center for Disease Control and Prevention. Cancers were classified by the Guideline for Chinese Cancer Registration and International Classification of Disease for Oncology, Third Edition (ICD-O). Sex-specific and age-specific crude incidence rates, standardized incidence rates, and cumulative incidence rates (0-74 years), as well as truncated age-standardized incidence rate (35-64 years) were calculated. The standardized incidence rate was calculated by the 2000 Population Census of China and Segi's world population structure (Chinese age-standardized incidence rate was referred to as ASIRC, and world age-standardized incidence rate as ASIRW) .

Results

There were 4 205 registered new cases of cancer from 2016 to 2020 in Cenxi. The crude cancer incidence rate was 98.77/10⁵. The ASIRC, ASIRW, cumulative incidence rate (0-74 years) and the truncated age-standardized incidence rate (35-64 years) were 85.48/10⁵, 82.54/10⁵, 9.08%, and 165.08/10⁵, respectively. The male crude incidence rate was higher than that in female (χ²=161.703, P<0.001). The crude cancer incidence rates for 0-34 year-old overall population, males and females were all under 34.00/10⁵, for 35-39 year-old overall population, males and females were 64.02/10⁵, 83.94/10⁵, 43.75/10⁵, respectively, and for 75-79 year-old were 437.83/10⁵, 597.17/10⁵, 292.76/10⁵, respectively, reaching the highest incidence rate. The top three cancers in terms of crude incidence rate for the overall population were liver cancer (23.47%), lung cancer (17.53%), and nasopharynx cancer (10.70%), for males were liver cancer (30.94%), lung cancer (20.84%), and nasopharynx cancer (12.51%), while for females were breast cancer (16.44%), lung cancer (12.12%), and liver cancer (11.31%) .

Conclusion

Compared to the Chinese average (ASIRC and ASIRW were 190.64/10⁵, 204.8/10⁵), and world average (ASIRW were 201.0/10⁵) from 2016 to 2020, Cenxi had lower overall standardized cancer incidence rates (ASIRC and ASIRW were 85.48/10⁵, 82.54/10⁵). The crude cancer incidence rate in males was higher than that of females. The crude cancer incidence rate reached its peak at the age range of 75-79 years for the overall population, males or females. The top three cancers in terms of crude incidence in the overall population were liver cancer, lung cancer and nasopharynx cancer.

Overview and Trends of Premature Deaths Due to Four Major Noncommunicable Diseases among Shenzhen Permanent Residents, 2014-2020

LIAO Jia, WEI Shuangyi, LIU Gang

2022, 25(32):  4085-4090.  DOI: 10.12114/j.issn.1007-9572.2022.0382

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Background

Noncommunicable diseases (NCDs) are increasingly prevalent in Chinese residents, and are happening younger and younger, which have become a major threat to population health.

Objective

To analyze the characteristics and trends of premature deaths due to major NCDs among Shenzhen permanent residents aged 30-69 from 2014 to 2020, providing a basis for the formulation of chronic disease prevention and control policies.

Methods

The cause-of-death data of Shenzhen permanent residents (30-69 years old) came from the all-cause-of-death surveillance system operated by the Shenzhen Center for Disease Control and Prevention. The causes were classified into four major NCDs including cancer (C00-C97), diabetes (E10-E14), cardiovascular and cerebrovascular diseases (I00-I99), and chronic respiratory disease (J30-J98) in accordance with the International Classification of Diseases, Tenth Revision (ICD-10). Crude mortality, age-standardized mortality and probability of premature death were used for analyzing deaths due to the four above-mentioned NCDs. The annual percentage change (APC) was used to measure the temporal trend of each index.

Results

During 2014-2020, no significant changes were found in the overall trends of crude mortality and age-standardized mortality of the four major NCDs (APC=-2.70%, P>0.05; APC=-2.00%, P>0.05), while the proportion of deaths due to the four major NCDs of all deaths (76.58% -82.63%) showed a significantly increasing trend (APC=1.20%, P <0.05). To be specific, the trend of crude mortality of cancer (APC=-1.90%, -0.90%; P>0.05), diabetes (APC=3.80%, 2.20%; P>0.05) and chronic respiratory diseases (APC=-1.30%, -0.60%; P>0.05) changed insignificantly, so did the trend of age-standardized mortality of them, while the crude mortality and age-standardized mortality (34.22%-48.85%) of cardiovascular and cerebrovascular diseases showed a notable decrease (APC=-4.70%, -4.60%; P<0.05). In women, the crude mortality and age-standardized mortality of diabetes demonstrated a notable decrease (APC=-17.00%, -17.00%; P<0.05), so did those of cardiovascular and cerebrovascular disease (APC=-7.10%, -6.10%; P<0.05). The probability of premature death caused by the four major NCDs during the period fluctuated from 10.17 to 12.45%, but with no significant changes (P>0.05). But the trend in the probability of premature death caused by cardiovascular or cerebrovascular disease showed an obvious decrease (APC=-5.10%, P<0.05). The probability of premature death from diabetes and cardiovascular and cerebrovascular diseases in women decreased (APC=-18.70%, -5.40%; P<0.05). The probability of premature death caused by the four major NCDs in males ranged from 12.78% to 17.09%, which was higher than that (6.59% to 8.13%) in females.

Conclusion

The crude mortality, age-standardized mortality and probability of premature death caused by cardiovascular and cerebrovascular disease among Shenzhen permanent residents showed a decreasing trend during 2014-2020. In particular, the crude mortality and age-standardized mortality and probability of premature death of cardiovascular and cerebrovascular disease and diabetes among females declined significantly. The probability of premature death of the four major chronic diseases fluctuated between 12.78%-17.09% in males and 6.59%-8.13% in females. The probability of premature death of the four major chronic diseases in males was higher than that in females.

Knowledge Updates

Hotspots and Trends in Research on Nutrition in Cirrhosis from 1991 to 2021: a Visualized Review

CHEN Ran, YANG Haoran, SHI Huilian, LIU Qiong, TANG Ting

2022, 25(32):  4091-4098.  DOI: 10.12114/j.issn.1007-9572.2022.0247

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Background

Cirrhosis is a chronic consumption disease, whose impact on patients' physical function and nutritional status has been increasingly valued by the academic community. It is helpful to promote the innovation and development in nutrition for cirrhosis in China by reviewing the hotspots in global research on nutrition for cirrhosis periodically.

Objective

To perform a bibliometric and visualized review of the development, hotspots, and trends of studies on nutrition for cirrhosis published from 1991 to 2021, providing a reference for future studies related to nutrition in cirrhosis.

Methods

The studies about nutrition in cirrhosis published during 1991-2021 were searched from the database of Web of Science. Collaboration and co-occurrence network analyses supported by CiteSpace were used for data mining and visualization analysis of countries, institutions, authors, keywords, and burst keywords relevant to studies of nutrition in cirrhosis .

Results

A total of 1 520 studies were finally included, the yearly number of these studies demonstrated a wave-like growth during the period of 1991-2021, in particular, it exceeded 100 in 2020 and 2021. The U.S. ranked first in terms of the number of published studies (424) and intermediary centrality value (0.32). As for institutions, Mayo Clinic (the U.S.) ranked first in terms of the number of published studies (25) and intermediary centrality value (0.08), followed by Gifu University (Japan), Cleveland Clinic (the U.S.), and Aarhus University Hospital (Denmark). Inter-institutional collaborative networks were formed in the U.S., with Mayo Clinic and Cleveland Clinic, as the core, and in Europe, with Charite (Germany) and Karolinska Institute (Sweden) as the core. A total of 891 authors were included in the collaborative network, represented by TANDON P and KAWAGUCHI T. High-frequency keywords included nutritional status, liver transplantation, and body composition. Sarcopenia was the keyword with the strongest citation bursts (strength 26.170 9) .

Conclusion

Nutritional assessment, liver transplantation and body composition may be hot topics in research on nutrition in cirrhosis. And the pathophysiological mechanisms of malnutrition and nutritional management in patients with cirrhosis and sarcopenia may be foci of future research.