Chinese General Practice

Expert Recommendations for Clinical Application of Trazodone Hydrochloride Sustained Release

PAN Jiyang, FANG Yiru, HU Shaohua, LU Zheng, SU Changjun, TANG Xiangdong, WANG Tao, WANG Wenqiang, YAO Zhijian, YUAN Yonggui, YU Huan, ZHAN Shuqin, ZHAO Zhongxin, ZHANG Xulai, ZHANG Ling, LI Lingjiang

2022, 25(33): 4099-4105. DOI: 10.12114/j.issn.1007-9572.2022.0532

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Trazodone hydrochloride sustained -release, as a multi-receptor binding drug, can exert different pharmacological effects at different doses and can improve a variety of psychiatric disorders. To further standardize the clinical application of trazodone hydrochloride sustained release, the expert writing group integrated domestic and international clinical trials, clinical practice guidelines, prescribing guidelines and clinical medication experience to prepare this expert recommendation for clinical application. This article mentions that trazodone hydrochloride sustained release is clinically applicable to depression, insomnia caused by various reasons, and also applied to generalized anxiety disorder, sexual dysfunction, post-traumatic stress disorder, substance dependence and withdrawal reactions and obsessive-compulsive disorder, and describes drug dosage, interactions, and precautions for use in special populations, with a view to providing clinicians with scientific and comprehensive medication guidance.

Efficacy and Safety of the Five Commonly Used External Therapies of TCM Combined with Conventional Western Medicine in Treating Diabetic Peripheral Neuropathy: a Bayesian Network Meta-analysis

LU Chunjian, LIU Wei, LIN Shaoxia, ZHU Yanxian, PI Min

2022, 25(33): 4106-4116. DOI: 10.12114/j.issn.1007-9572.2021.00.536

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Background

Diabetic peripheral neuropathy (DPN) is one of the common complications in diabetic patients, and TCM external therapies represented by acupuncture has some advantages in treating DPN, but what combination of TCM external therapies and conventional Western medicine has the best efficacy in treating DPN is still lacking evidence-based medical studies.

Objective

To evaluate the efficacy and safety of the five commonly used external therapies of TCM combined with conventional Western medicine in treating DPN by Bayesian Network Meta-analysis.

Methods

The five commonly used external therapies of TCM confirmed by pre-survey were acupuncture, foot bath, acupoint massage, acupoint injection and moxibustion, respectively. The Cochrane Library, Web of Science, PubMed, SinoMed, VIP, Wanfang Data and CNKI were searched by computer from their inception to December 29th, 2020, to screen randomized controlled trials (RCTs) about efficacy and safety of the five commonly used external therapies of TCM combined with conventional Western medicine in treating DPN. RevMan 5.3, Stata 15.0 and ADDIS 1.16.6 software were used for plotting and data analysis.

Results

A total of 44 RCTs were enrolled, including 3 471 patients with DPN. Bayesian network Meta-analysis showed that the five commonly used external therapies of TCM combined with Western medicine were all superior to conventional Western medicine alone in improving overall efficacy rate, of which acupuncture had the best effect〔OR=0.20, 95%CI (0.11, 0.36) 〕. Except for acupoint massage, the other four commonly used external therapies of TCM combined with conventional Western medicine were all superior to conventional Western medicine alone in improving median nerve motor conduction velocity (MNCV) , with acupoint injection being the most effective〔MD=-4.50, 95%CI (-5.91, -3.11) 〕. The five commonly used external therapies of TCM combined with conventional Western medicine were all superior to conventional Western medicine alone in improving median nerve sensory conduction velocity (SNCV) , in which moxibustion had the best effect〔MD=-9.03, 95%CI (-12.59, -5.47) 〕. Except for acupoint massage, the other four commonly used external therapies of TCM combined with conventional Western medicine were all superior to conventional Western medicine alone, with moxibustion having the best effect〔MD=-6.34, 95%CI (-9.31, -3.30) 〕. Except for acupoint massage, the other four commonly used external therapies of TCM combined with conventional western medicine were all superior to conventional Western medicine alone in improving SNCV of the common peroneal nerve, with acupuncture showing the best efficacy〔MD=-5.70, 95%CI (-8.03, -3.31) 〕.

Conclusion

Acupuncture combined with conventional Western medicine is recommended preferentially in treating DPN based on available literature evidence, especially in improving overall efficacy rate and SNCV of the common peroneal nerve, but more high-quality studies are still needed for further validation.

Meta Analysis of the Efficacy and Safety of Rennin-angiotensin-aldosterone System Iinhibitors in Patients with COVID-19 Associated with Hypertension

JIA Dongxia, PENG Junchen, LIU Sitai, LI Lan, ZHENG Hang, HOU Liangping, YANG Xianzheng, HUANG Qiangpei, GAO Chao

2022, 25(33): 4117-4122. DOI: 10.12114/j.issn.1007-9572.2022.0202

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Background

The spreading epidemic of novel coronavirus (corona virus disease 2019, COVID-19) pneumonia poses a serious challenge to global life health and disease control, with significantly higher mortality rates among individuals infected with COVID-19 comorbid underlying disease. Inhibitors of the rennin-angiotensin-aldosterone system (RAASi) , an important class of anti-hypertensive drugs, have been found to increase the morbidity and mortality of COVID-19. This study aimed to clarify the efficacy and safety of RAASi treatment in COVID-19 patients with hypertension.

Objective

To systematically evaluate the efficacy and safety of RAASi therapy in COVID-19 patients with hypertension.

Methods

PubMed, Embase, Cochrane Library and China National Knowledge Infrastructure (CNKI) were searched from inception to January 2022. A publicly available case-control studies of COVID-19 patients with hypertension treated with RAASi versus non RAASi therapy were included, and outcome measures were overall mortality, incidence of critical illness, incidence of acute respiratory distress syndrome (ARDS) , incidence of myocardial injury, and incidence of renal injury, with meta-analysis performed using Revman 5.3.

Results

Seventeen studies with a total of 5 689 patients were included, of whom 2 168 received RAASi therapy and 3 521 did not. Meta analysis showed that overall mortality was lower in COVID-19 comorbid hypertensive patients treated with RAASi compared with non RAASi treated patients 〔OR=0.54, 95%CI (0.41, 0.72) , P<0.000 1〕; Between RAASi treated and non RAASi treated COVID-19 patients associated with hypertension, the incidence of critical illness 〔OR=0. 92, 95%CI (0.79, 1.08) , P=0.30〕, the incidence of ARDS 〔OR=0.81, 95%CI (0.57, 1.13, P=0.22〕, the incidence of myocardial injury 〔OR=1.03, 95%CI (0.83, 1.27) , P=0.82〕, and the incidence of kidney injury 〔OR=1.13, 95%CI (0.78, 1.66) , P=0.52〕, differences were not statistically significant.

Conclusion

Treatment with RAASi in COVID-19 patients with hypertension reduced the overall mortality rate, and did not increase the incidence of critical illness, ARDS, myocardial injury, and renal injury in COVID-19 patients with hypertension. RAASi therapy is effective and safe in treating patients with COVID-19 combined with hypertension.

Levels of Relevant Inflammatory Factors and Oxidative Stress Markers in Alcoholic Myopathy: a Meta-analysis

WANG Nan, Motuziuk OLEKSANDR, Mishchenko IRYNA, ZHOU Yingting

2022, 25(33): 4123-4129. DOI: 10.12114/j.issn.1007-9572.2022.0214

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Background

Alcoholism can lead to alcoholic myopathy. Although there are over ten biomarkers used to evaluate this disease, their diagnostic value remains controversial.

Objective

To systematically evaluate the effects of alcoholic myopathy on levels of relevant inflammatory factors and oxidative stress markers.

Methods

The VIP Database for Chinese Technical Periodicals, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure, Web of Science, PubMed, Embase and Cochrane Library databases were searched for animal intervention studies on inflammatory factors and oxidative stress markers in alcoholic myopathy from February 1, 1990 to August 31, 2021 to retrieve. RevMan 5.4.1 was used for Meta-analysis. Outcome measures included reduced glutathione (GSH) and malondialdehyde (MDA) levels as well as the mRNA expression levels of insulin-like growth factor 1 (IGF-1) and interleukin 6 (IL-6) .

Results

Ultimately, 17 animal interventionstudies were included, and the results of Meta-analysis showed that the levels of IGF-1 mRNA expression〔SMD=-3.09, 95%CI (-5.75, -0.43) , P=0.02〕and GSH levels〔SMD=-4.20, 95%CI (-6.24, -2.17) , P<0.000 01〕in the experimental group were lower than those in the control group. The levels of IL-6 mRNA expression〔SMD=3.75, 95%CI (2.93, 4.57) , P<0.000 01〕and MDA levels〔SMD=0.97, 95%CI (0.64, 1.29) , P<0.000 01〕were higher in the experimental group than those in the control group.

Conclusion

Animals with alcoholic myopathy show decreased IGF-1 mRNA expression and GSH levels but increased IL-6 mRNA expression and MDA levels.

Risk Factors for All-cause Mortality in Patients with Coronary Heart Disease and Hematologic Malignancies

QIN Changyu, CHEN Meixiang, RUAN Zheng, XU Lin

2022, 25(33): 4130-4138. DOI: 10.12114/j.issn.1007-9572.2022.0359

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Background

As the aging population has progressed and oncology treatments have revolutionized, the clinical situation of cardiovascular disease complicating malignancy has become more common, and the field of cardio-oncology has gained much attention. When hematological malignancy is combined with coronary heart disease, the condition can be aggravated by pathological mechanisms such as imbalance of oxygen supply and bleeding coagulation abnormalities. However, the factors affecting the prognosis have rarely been reported.

Objective

To investigate the influencing factors of all-cause mortality in patients with coronary heart disease combined with hematological malignancies.

Methods

Data from the medical records of General Hospital of Southern Theater Command between January 2013 and December 2020 were retrieved to select patients whose diagnostic book homepage contained the keywords coronary heart disease or coronary atherosclerotic heart disease and hematological malignancy (leukemia or lymphoma or multiple myeloma) to establish a repository of patients with coronary heart disease combined with hematological malignancy. Patients' clinical data were collected and followed up for survival status, major adverse cardiovascular events (MACE) and the occurrence or absence and time of major bleeding events. They were divided into survival and death groups by survival status, and statistical analysis was performed for each indicator in the two groups. Multivariate Cox regression analysis was used to explore the risk factors of all-cause mortality in patients with coronary heart disease combined with hematological malignancies.

Results

A total of 68 patients were finally included in the study, 52 died (76.47%) , the median survival time was 10.93 months, and the median follow-up time was 67.33 months. Compared with the survival group, patients in the death group were older, had faster heart rate at admission, lower body mass index, smaller body surface area, lower hemoglobin, albumin level, higher cystatin C level, higher proportion of elevated brain natriuretic peptide, and higher proportion of chemotherapy and stem cell transplantation (P<0.05) . Multivariate Cox regression analysis showed that elevated body mass index〔HR=0.841, 95%CI (0.761, 0.930) , P=0.001〕, receipt of chemotherapy〔HR=0.340, 95%CI (0.182, 0.637) , P=0.001〕, increased albumin level〔HR=0.934, 95%CI (0.889, 0.982) , P=0.008〕 were independent protective factors for death events. Elevated fibrinogen〔HR=1.635, 95%CI (1.291, 2.071) , P<0.001〕, and platelet count less than 100×10⁹/L〔HR=2.500, 95%CI (1.336, 4.678) , P=0.004〕 were independent risk factors for mortality.

Conclusion

Patients with coronary heart disease and hematological malignancies have poor prognosis, and the risk factors associated with all-cause mortality are elevated fibrinogen and platelet count less than 100×10⁹/L.

Relationship of Carotid Intima-media Thickness and Epicardial Fat Thickness with Mild Cognitive Impairment in Elderly Patients with Masked Hypertension

GONG Qiyun, SHAO Pingle, HUI Jiamou

2022, 25(33): 4139-4144. DOI: 10.12114/j.issn.1007-9572.2022.0473

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Background

Population aging has become a prominent problem in recent years. At present, there are many studies on hypertension and mild cognitive impairment (MCI) , but few studies on the relationship between masked hypertension (MH) and MCI in elderly patients.

Objective

To investigate the relationship of carotid intima-media thickness (CIMT) and epicardial fat thickness (EAT) with cognitive dysfunction in elderly patients with MH, to provide a theoretical basis for early detection of mild changes in cognitive function in this group.

Methods

A total of 255 cases were selected from Municipal Hospital of Traditional Chinese Medicine of Jiayuguan from January 2019 to February 2022, including 173 elderly inpatients and outpatients diagnosed with MH (MH group) , and 82 elderly healthy people with normal blood pressure (control group) . Ambulatory blood pressure monitoring, CIMT and EAT measurement were performed in both groups, and relevant indicators were recorded. The Montreal Cognitive Assessment (MoCA) scale was used to assess the cognitive function. Binary Logistic regression analysis was used to explore the factors associated with MCI in MH.

Results

Compared with control group, MH group had greater average age, and higher levels of average clinic systolic blood pressure (SBP) , clinic diastolic blood pressure (DBP) , 24 h ambulatory SBP, 24 h ambulatory DBP, 24 h SBP coefficient of variation, 24 h DBP coefficient of variation, CIMT and EAT, as well as less average years of education (P<0.05) . The average scores of executive function/visuospatial ability, animal naming, attention, language, abstraction, delayed recall and average total MoCA score in MH group were significantly lower than those in control group (P<0.05) . Correlation analysis showed that the total score of MoCA was negatively correlated with age, 24 h DBP coefficient of variation, CIMT, and EAT (P<0.001) . Binary Logistic regression analysis indicated that CIMT〔OR=48.282, 95%CI (10.734, 217.168) 〕, EAT〔OR=2.124, 95%CI (1.057, 4.269) 〕 were associated with MCI in MH (P<0.05) .

Conclusion

Increased age, lower education level, increased 24 h SBP coefficient of variation, and increased CIMT and EAT values are risk factors for cognitive dysfunction in elderly patients with MH.

Duration of Yifei Moxibustion with Clinical Efficacy in COPD: Effectiveness Improvement Study and Applicability Analysis

LIN Xiaohong, SHI Xinping, WANG Minghang, YANG Jiang, LI Suyun, LI Jiansheng

2022, 25(33): 4145-4152. DOI: 10.12114/j.issn.1007-9572.2022.0332

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Background

Our previous study showed that Yifei moxibustion has good effect on chronic obstructive pulmonary disease (COPD) in stable stage, but the effect could be enhanced according to the suggestions of an expert questionnaire survey. It is of great significance to carry out clinical research on the relationship of moxibustion duration with clinical efficacy and suitability in COPD.

Objective

To study and optimize the appropriate duration of moxibustion treatment in COPD, and to evaluate its clinical efficacy and suitability.

Methods

One hundred and twenty patients with stable COPD were recruited from the First Affiliated Hospital of Henan University of Chinese Medicine from June to July 2017, and randomly divided into groups A and B with SAS software. Both groups received routine western medicine treatment and one course of Yifei moxibustion treatment (1.5 h each time for group A, and 2 h each time for group B, once every 15 days, for a total of six times in three months) . The primary outcome index was the number of colds during treatment, and the secondary outcome indices included clinical symptoms and signs scores, COPD Assessment Test (CAT) , pulmonary function, suitability evaluation〔using the Visual Analogue Scale (VAS) 〕, and the safety was evaluated.

Results

Except 29 dropouts, 91 cases (47 in group A and 44 in group B) were included in the Per Protocol Set and analyzed with full data set analysis. The results of repeated measures ANOVA showed that the main effects on the number of colds, score of chest tightness, CAT score and VAS score were significant between groups (P<0.05) . There were significant intergroup differences in the number of colds, the total score of clinical symptoms and signs, the score of each of the clinical symptoms and signs, the score of each of the clinical symptoms and signs, CAT score and VAS score at different time points (P<0.05) . No adverse events occurred in both groups.

Conclusion

Both types of Yifei moxibustion could reduce the number of colds, improve the cough, chest tightness and other clinical symptoms as well as the quality of life in stable COPD patients. But the efficacy of Yifei moxibustion lasting for 1.5 h each time was better, and was more applicable.

Clinicopathological Features of Anticancer Drug-induced Kidney Injury

GENG Tonghui, LI Han, JIN Jingjing, CHENG Meijuan, ZHANG Shenglei, BAI Yaling, XU Jinsheng

2022, 25(33): 4153-4158. DOI: 10.12114/j.issn.1007-9572.2022.0372

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Background

The prevalence of anticancer drug-induced kidney injury is increasing, but related renal pathology studies are still rare.

Objective

To analyze the clinicopathological characteristics of patients with anticancer drug-related kidney injury.

Methods

We selected 112 cancer inpatients aged 18 years or older with kidney injury (kidney injury occurred after cancer or nearly at the same time as cancer, and may be directly or indirectly associated with anticancer treatment) detected by kidney biopsy from Department of Nephrology, the Fourth Hospital of Hebei Medical University from October 2013 to August 2021. We assigned those (n=65) who were previously treated with chemotherapy, molecularly targeted drugs or immune checkpoint inhibitors and other systemic treatments to an anticancer drug group, and other cases (n=47) to a non-use anticancer drug group. We collected their demographics, laboratory examination and pathological data, and analyzed the clinical features and pathological characteristics of kidney of those with anticancer drug-related kidney injury.

Results

In the anticancer drug group, acute kidney injury (AKI) occurred in 30 (50.8%) out of 59 cases of solid cancer, and in 4 out of 6 cases of hematological cancer. In non-use anticancer drug group, AKI occurred in 11 (31.4%) out of 35 cases of solid cancer, and in 6 (50.0%) out of 12 cases of hematological cancer. The serum creatinine level increased after treatment in the anticancer drug group (P<0.001) . Anticancer drug group and non-use anticancer drug group had significant differences in sex ratio, smoking prevalence, mean serum albumin and elevated urinary protein excretion prevalence (P<0.05) , but had no significant differences in mean age, hemoglobin, serum creatinine, urea nitrogen, uric acid, D-dimer, total cholesterol, triacylglycerol, and 24-hour urinary protein quantification, as well as prevalence of diabetes, hypertension, and AKI (P>0.05) . Solid cancer patients with anticancer drug treatment had higher prevalence of tubulointerstitial injury (P=0.023) and lower prevalence ofmembranous nephrosis (P=0.004) compared with those without anticancer drug treatment. Renal tubulointerstitial injury was the main pathological manifestations in the anticancer drug group〔34 cases (52.3%) 〕. Membranous nephropathy〔18 cases (38.3%) 〕and tubulointerstitial injury〔18 cases (38.3%) 〕were main pathological manifestations in the non-use anticancer drug group.

Conclusion

There are various clinical and pathological types of anticancer drug-induced kidney injury. The application of anticancer drug may cause damage to renal function, so priority should be given to the prevention of renal tubulointerstitial injury during the treatment.

Effects of High-intensity Interval Training on Cardiac Structure and Function in a Rat Model of Myocardial Infarction

JIA Siqi, WANG Di, LU Yan, JIA Yongping

2022, 25(33): 4159-4167. DOI: 10.12114/j.issn.1007-9572.2022.0292

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Background

As one exercise program of cardiac rehabilitation, the role of high-intensity interval training (HIIT) in improving myocardial infarction is still controversial, and the mechanism is unclear.

Objective

To investigate the effect of HIIT on improving the cardiac structure and function in a rat model of myocardial infarction.

Methods

An experiment was conducted from September 2020 to October 2021. From a random sample of 78 3-month-old male SD rats, 56 were eventually included, and 14 of them were randomly selected as sham-surgery group (Sham group) , and the remaining 42 rats were equally randomized into MI-sedentary group (MI-SED group) , MI-HIIT group (MI-HIIT group) , and MI-medium-intensity continuous training (MI-MICT group) after being used for preparing a model of acute myocardial infarction (AMI) . Sham group and MI-SED group were not trained, MI-HIIT group received high-intensity and medium-intensity training alternately, MI-MICT group received medium-intensity continuous training. After 1 week of AMI modeling, MI-HIIT and MI-MICT groups received 8 weeks of training. At the end of 4 weeks of training, 7 rats in each of the 4 groups were randomly selected for detecting cardiac ultrasound, and weighing body weight, then were sacrificed, and their heart weight and serum tumor necrosis factor (TNF-α) were measured, cardiac mass index was calculated, and heart tissues were measured using H&E staining, Masson's Trichrome staining and immunohistochemical staining. At the end of 8 weeks of training, the same operation was performed on the remaining 7 rats in each of the groups.

Results

After 4 weeks of training, the standardized cardiac mass index of MI-HIIT group was higher than that of each of the other three groups (P<0.05) . The sham group had higher ejection fraction (EF) , fractional shortening (FS) and left ventricular end-systolic posterior wall thickness (LVPWs) than MI-HIIT and MI-MICT groups (P<0.05) . MI-SED group had lower EF, FS, and LVPWs, and higher left ventricular end-systolic diameter (LVESD) than MI-HIIT and MI-MICT groups (P<0.05) . After 8 weeks of training, MI-HIIT group had lower body weight than sham and MI-SED groups, higher heart weight than sham, MI-SED and MI-MICT groups, and higher standardized cardiac mass index than sham and MI-MICT groups (P<0.05) . MI-HIIT group demonstrated higher EF, LVESD, left ventricular end-diastolic diameter (LVEDD) , left ventricular end-systolic anterior wall thickness (LVAWs) than sham and MI-SED groups (P<0.05) . Moreover, MI-HIIT group also showed higher FS and LVPWs than MI-SED group (P<0.05) . HE staining results showed that MI-HIIT group had significantly improved inflammatory changes of heart tissue and more closely arranged myocardial cells at the end of the 8th week of training compared with at the end of 4 weeks of training. Masson's Trichrome staining results showed that after 8 weeks of training, the proportion of myocardial fibrillar collagen in myocardial tissues of MI-SED group was higher than that of MI-HIIT and MI-MICT groups. Immunohistochemical results showed that MI-HIIT group had more newly formed blood vessels in cardiac tissues than sham and MI-SED groups after 4 and 8 weeks of training, so did the MI-MICT group. The number of newly formed blood vessels in cardiac tissues of MI-HIIT group was more than that in MI-MICT group after 8 weeks of training. MI-HIIT group had higher serum TNF-α than MI-SED group after 4 weeks of training. After 8 weeks of training, the serum TNF-α in MI-HIIT group was higher than that in MI-MICT group.

Conclusion

HIIT performed in the early stage of AMI could improve cardiac mass index, induce early inflammatory response in myocardial tissue, reduce myocardial fibrosis, promote angiogenesis and ventricular remodeling. HIIT had better overall effect than MICT.

Diagnostic Significance of Suggested Immobilization Test in Restless Leg Syndrome

ZHANG Wei, CHANG Yuan, FENG Junjun, HAN Fang

2022, 25(33): 4168-4172. DOI: 10.12114/j.issn.1007-9572.2022.0212

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Background

Restless leg syndrome (RLS) is a type of sensorimotor disorder, and clinical workers have made some recent developments in its pathological mechanism and treatment. Epidemiological studies have verified that RLS is notably associated with neuro-psychological diseases, kidney disease, cerebro-cardiovascular diseases, nutritional and metabolic diseases, and pregnancy disorders. The diagnostic rate of RLS is low due to lack of specific clinical symptoms, clear genetic and biological markers, and polysomnography (PSG) diagnostic criteria. There are several sleep centers in foreign countries where the suggested immobilization test (SIT) has been applied in clinical treatment and research about RLS.

Objective

To evaluate the clinical significance of SIT in RLS diagnosis.

Methods

The study enrolled 220 patients who visited the PKU-UPenn Sleep Center, Peking University International Hospital with a main complaint of discomfort in bilateral lower limbs during daytime rest or before sleep, and 150 healthy volunteers from January 2016 to June 2021. Discomfort in lower limbs was measured in healthy volunteers and RLS cases at baseline. The actual limb movement index (LMI) , periodic limb movements while awake index (PLMWI) , and periodic limb movement in sleep index (PLMSI) were evaluated with PSG. PLMWI≥40 times/h during SIT and >3 increment of self-assessment score of lower limb discomfort after SIT than the last assessment or one of early assessments were considered as positive SIT.

Results

Among the 220 RLS patients, 9 patients did not finish the SIT due to severe symptoms-induced unbearable discomfort during resting sit, the other 211 patients (95.9%) together with all healthy volunteers (100.0%) who successfully finished the SIT were finally included. There were significant differences in LMI, PLMWI and PLMSI during the SIT between healthy volunteers and patients (P<0.05) . The positive rates of SIT in RLS patients and healthy volunteers were 79.6% (168/211) and 10.0% (15/150) , respectively.

Conclusion

SIT is easily operable, it can be used as an effective auxiliary diagnostic tool for RLS.

Spontaneous Brain Activities in Hyperthyroidism Patients Assessed Using Fractional Amplitude of Low-frequency Fluctuation

WU Xiaoran, WANG Xiaoyue, GENG Yibo, ZHANG Hongxing, ZHANG Haisan

2022, 25(33): 4173-4178. DOI: 10.12114/j.issn.1007-9572.2022.0498

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Background

Hyperthyroidism is a common endocrine psychosomatic disease, which is often accompanied by negative emotions, seriously affecting the prognosis of patients. Moreover, it is associated with more than 5 times more higher risk of committing suicide. Therefore, it has certain clinical and social significance to explore the neuroimaging characteristics of brain damage in patients with hyperthyroidism.

Objective

To analyze the abnormal patterns of spontaneous brain activity measured by resting-state functional magnetic resonance imaging (rs-fMRI) , and the neuroimaging characteristics of brain damage in patients with hyperthyroidism.

Methods

Participants were recruited from December 2014 to June 2016, including 25 hyperthyroidism outpatients with ¹³¹I therapy from Xinxiang Central Hospital, and 28 sex-, age-, and education level-matched healthy volunteers from the same hospital and the community near the hospital. Symptom Checklist-90 (SCL-90) was used to assess the mental health. rs-fMRI was performed to measure the fractional fractional amplitude of low-frequency fluctuation (fALFF) to reflect local spontaneous brain activity. Correlations of the mean fALFF (mfALFF) and with clinical variables and psychological symptoms were analyzed.

Results

Hyperthyroidism patients had higher mean scores of anxiety and anger-hostility than controls (P<0.05) . Hyperthyroidism patients had higher mean mfALFF values in the right cerebellar vermis region 7 (MNI: 3, -75, -27; t=4.381) , left thalamus (MNI: -6, -6, 0; t=3.545) , and right thalamus (MNI: 6, -3, 3; t=4.356) , and lower mean mfALFF values in the left posterior cerebellar lobe (MNI: -39, -81, -27; t=-3.402) , left orbital middle frontal gyrus (MNI: -9, 57, 0; t=-5.253) and left inferior frontal gyrus (MNI: -51, 15, 18; t=-3.747) . Correlation analysis showed that the mfALFF value of right cerebellar vermis region 7 was negatively correlated with the score of anxiety (r=-0.419, P=0.037) or anger-hostility (r=-0.402, P=0.046) .

Conclusion

The abnormal spontaneous activity in the right cerebellar vermis may be an important imaging marker of brain damage in hyperthyroidism, and may be imaging evidence for the studying of neuropathological mechanism of negative emotion in hyperthyroidism.

Effect of Depressive Symptoms on the Adherence to Continuous Positive Airway Pressure in Obstructive Sleep Apnea Patients Using a Path Analysis-based Approach

YI Huijie, LI Jianxiang, ZHANG Chi, XU Liyue, DONG Xiaosong, HAN Fang

2022, 25(33): 4179-4184. DOI: 10.12114/j.issn.1007-9572.2022.0265

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Background

The treatment adherence is closely related to the effect of continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) , which is also strongly influenced by patients' psychosocial characteristics. However, the influence of depression symptoms on the adherence to CPAP needs to be further explored.

Objective

To evaluate the relationship of depression symptoms with adherence to CPAP, and the pathwaybetween the associated factors in OSA patients.

Methods

A total of 177 patients who were diagnosed with OSA and treated with CPAP in the Respiratory and Sleep Medicine Center, Peking University People's Hospital from May 2019 to July 2021 were selected. The general information, disease severity and adherence to CPAP were evaluated. The prevalence of depression symptoms was measured by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) . The severity of insomnia was assessed by the Insomnia Severity Index (ISI) . The influence of daytime sleepiness on activities of daily living was measured by the 10-item Functional Outcomes of Sleep Questionnaire (FOSQ-10) . The 12-item Short Form Health Survey (SF-12) was used to evaluate the quality of life. The relationships among variables were determined by path analysis.

Results

The prevalence of depressive symptoms in OSA patients was relatively high (19.7%, 35/177) in our study. Depression symptoms were associated with increased insomnia prevalence (r=0.65, P<0.05) , and decreased levels of activities of daily living (r=-0.51, P<0.05) and quality of life (r_PCS=-0.27, P<0.05; r_MCS=-0.72, P<0.05) . In addition, depressive symptoms had no relationship on the adherence to CPAP (r=0.09, P>0.05) , but could increase the adherence to CPAP by decreasing the activities of daily living (β=0.078, P<0.01) .

Conclusion

Depressive symptoms were significantly associated with insomnia, decreased quality of life and activities of daily living in OSA patients, and could increase patients' adherence to CPAP through decreasing the activities of daily living.

Relationship between Pulse Oxygen Desaturation Rate and Heart Rate Fluctuation Rate and Arrhythmias in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

LI Yong, WANG Ying, CHEN Xun, LIN Wei, ZHANG Kai, DING Ning

2022, 25(33): 4185-4190. DOI: 10.12114/j.issn.1007-9572.2022.0333

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Background

Arrhythmias are common complications in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) , however their occurrence and severity are not completely consistent with the severity of their disease per se. Our previous study found that pulse oxygen desaturation rate (ODR) was an independent predictor of the development of hypertension in OSAHS patients. We hypothesized that sleep apnea related ODR and heart rate fluctuation rate (HRFR) may predict the occurrence of arrhythmias in OSAHS patients.

Objective

To observe the correlation between ODR, HRFR and the occurrence of arrhythmias, and to explore the predictive value of ORD and HRFR on the occurrence of arrhythmias.

Methods

Polysomnography and Holter monitoring were performed on 36 patients who visited the sleep disordered breathing specialized outpatient clinic of the First Affiliated Hospital of Nanjing Medical University between January and June 2021, while basic clinical information of the patients was collected. Taking the median number of arrhythmic events as the cutoff value, the patients were divided into two groups: the patients with low incidence of arrhythmia group (<105 events) and with high incidence of arrhythmias group (≥105 events) . ODR and HRFR were analyzed for correlation with arrhythmias and Logistic regression was performed for analysing the predictors of arrhythmia.

Results

Compared with low incidence of arrhythmia group, the patients with high incidence of arrhythmias had higher ODR and HRFR (P<0.05) . Correlation analysis showed that the number of total arrhythmic events was positively correlated with ODR, mean heart rate fluctuation value, and HRFR (r_s=0.472, 0.719, 0.360, and 0.393, respectively, P<0.05) . Multivariate Logistic regression analysis showed that ODR〔OR=77.849, 95%CI (5.250, 1 154.301) , P<0.05〕and HRFR 〔OR=9.981, 95%CI (1.000, 105.600) , P=0.05〕were independent risk factors for arrhythmic events. The area under the receiver operator characteristic (AUC) of ODR and HRFR for predicting multiple arrhythmias were 0.932 〔95%CI (0.830, 0.941) 〕 and 0.753 〔95%CI (0.590, 0.916) , respectively.

Conclusion

ODR and HRFR are associated with the occurrence of arrhythmias and can be used for predicting the occurrence of arrhythmic events in patients with OSAHS.

New Advances in the Value of the Normal Urinary Albumin as a Predictor of Multiple Diseases

SUN Zhenzhen, LIU Huanhuan, CHEN Kaining, LOU Qingqing

2022, 25(33): 4191-4195. DOI: 10.12114/j.issn.1007-9572.2022.0240

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The association of the normal range of urinary albumin and its associated diseases (mainly including diabetic kidney diseases, diabetic retinopathy, cardiovascular disease, and metabolic syndrome) has been an increasing concern, and the range of normal urinary albumin has been questioned by a growing number of scholars. We reviewed the association of the normal range of urinary albumin with the aforementioned diseases and the possible mechanism of actions, to assess the value of normal-range urinary albumin as a predictor of the diseases, and to provide a basis for future redefinition of the threshold for the normal range of urine albumin.

Progress in Clinical Treatment of Heart Failure with Preserved Ejection Fraction Combined with Depression

LIU Xianling, HONG Jian, WANG Kai, QIAN Lijun, SUN Yan, MA Wenjie, LI Zhongming, XU Di

2022, 25(33): 4196-4202. DOI: 10.12114/j.issn.1007-9572.2022.0315

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Heart failure with preserved ejection fraction (HFpEF) is a common type of heart failure (HF) , and previous treatments that primarily target heart failure with reduced ejection fraction (HFrEF) do not benefit the patients with HFpEF because of the differences in their pathophysiological mechanisms, resulting in high mortality and poor prognosis. Whereas depression is one of the most common mental and psychological problems, caused by various reasons and characterized by a pronounced and long-lasting low spirits, with various degrees of cognitive and behavioral changes. Those who are severely ill even present self-injurious and suicidal behavior. With intensive research into HFpEF, it has emerged that depression has become one of the most common comorbidities in HFpEF and that the two interact to contribute to poor prognosis for patients. Currently, relevant studies in HFpEF with depression suggested that some drugs could improve short term symptoms and clinical prognosis in such patients. This paper aimed to review the comorbid mechanism, research status and the latest progress of related treatment of HFpEF complicated with depression. It is found that sodium glucose cotransporter 2 (SGLT2) inhibitors, angiotensin receptor enkephalinase inhibitors (ARNI) and statin drugs play important roles in the field of HF and psychophysiology. They can not only improve the cardiac function and prognosis of HFpEF patients, but also have the effect of anti-depression, thus to provide references for clinical study and treatment.

Advances in the Diagnosis and Treatment of Sleep-disordered Breathing in Neuromuscular Disease

DING Qidi, CAO Zhaolong, HAN Fang

2022, 25(33): 4203-4206. DOI: 10.12114/j.issn.1007-9572.2022.0266

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Sleep-disordered breathing (SDB) occurs frequently in neuromuscular disease (NMD) patients, and early diagnosis and treatment of which are of great value in the management of NMD. We reviewed the advances in pathogenesis, clinical manifestations, diagnostic and treatment modalities of SDB in NMD. It is noteworthy that although the development of portable sleep monitoring devices is ongoing, the diagnostic value of them for such patients has not been fully clarified, and more attention and further research are still needed.

A Brief Talk on the First Diagnosis and Treatment of Adult Hematuria

QIN Hongli, REN Jingjing

2022, 25(33): 4207-4210. DOI: 10.12114/j.issn.1007-9572.2022.0286

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Hematuria is a common clinical symptom, especially asymptomaticmicrohematuria (AMH) , which is more common in the first diagnosis in general practice clinics or primary health institutions. In this paper, we summarized the characteristics and evaluation contents of adults with hematuria by reviewing the relevant literatures. We conclude that the etiological treatment is fundamental, and it is important to follow-up for those whose cause is unknown. Hopefully, this paper can provide reference for the general practitioners to deal with adult hematuria.

Cronkhite-Canada Syndrome: Report of Three Cases and Literature Review

LI Shuying, LIN Yingmin, WANG Min

2022, 25(33): 4210-4216. DOI: 10.12114/j.issn.1007-9572.2022.0244

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Cronkhite-Canada syndrome (CCS) is currently considered to be a non-genetic disorder and a relatively rare clinical condition that is characterized endoscopically by multiple polyps in the gastrointestinal tract and clinically manifested by gastrointestinal symptoms, skin pigmentation, hair loss, and nail loss. In this paper, we analyzed the clinical characteristics and treatment procedures of three patients diagnosed with CCS at Qilu Hospital of Shandong University from August 2012 to September 2021 and reviewed the relevant literature. The diagnosis of CCS is based on medical history, physical examination, endoscopic findings of gastrointestinal polyps, and histopathology, with gastrointestinal endoscopy being the most direct means of examination. All three patients presented endoscopically with diffuse multiple polyps in the gastrointestinal tract, had hair and nail loss and were free of HP infection. Moreover, case 1 and case 3 both had reduced serum albumin levels; case 2 and case 3 were negative for antinuclear antibodies (ANA) , case 1 was not checked for ANA. Glucocorticoids and proton pump inhibitors (PPI) were the main pharmacological treatments for CCS. Case 1 was not treated with glucocorticoids, but only PPI and supportive treatment, and later developed bloody stools and intestinal necrosis and underwent total gastrectomy for gastric cancer 6 years after the onset of the disease. Cases 2 and 3 were improved after being treated with prednisone and PPI. Early diagnosis, glucocorticoid-based pharmacotherapy, regular gastrointestinal endoscopy, and new treatment options may contribute to a better prognosis, and the reduction in possibilities of missed diagnosis or misdiagnosis of CCS via improving clinicians' knowledge and understanding of the disease.

Hot Spots and Cutting Edge Trends in CiteSpace based Research on Social Anxiety among College Students

LI Keke, YU Wenbing, LI Shuoqi, JIAO Qianxin, JU Mingxiao, GAO Lili, WANG Caixia

2022, 25(33): 4217-4226. DOI: 10.12114/j.issn.1007-9572.2022.0390

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Background

Mental health problems among college students have become increasingly prominent. Social anxiety is one of the prevalent psychological problems among college students.

Objective

To explore the research hot spots, frontiers and trends on social anxiety among college students, and provide reference for researchers participating in the research of college students' social anxiety in the future.

Methods

643 English articles in database of Web of Science (WOS) and 166 Chinese articles in database of China National Knowledge Infrastructure (CNKI) from 2000 to 2021 were analyzed using CiteSpace on August 27, 2021.

Results

The number of English articles on social anxiety among college students showed an increasing trend from 2000 to 2021. The research hot spots and frontiers of social anxiety among college students were mainly focused on substance abuse, mobile phone and internet addiction, negative evaluation fear, racial differences, psychological intervention and COVID-19 epidemic. The future research trends were mainly focused on the mechanism of substance abuse and mobile phone addiction.

Conclusion

Chinese scholars can refer to the research hot spots, trends and the differences between domestic and foreign research shown by this visual analysis, and focus on the related problems of substance abuse and mobile internet addiction among college students with social anxiety.

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