Table of Content

20 December 2022, Volume 25 Issue 36

Previous Issue    Next Issue

Guide Interpretation

Interpretation of Consensus on Diagnosis and Management of Cushing's Disease: a Guideline Update from the Pituitary Society——Medical Therapies

TANG Yu, TAN Huiwen, LI Jianwei, YU Yerong

2022, 25(36):  4483-4490.  DOI: 10.12114/j.issn.1007-9572.2022.0469

Asbtract ( )   HTML ( )   PDF (2442KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Cushing's disease, the most common cause of endogenous Cushing's syndrome, is hypercortisolemia caused by adrenocorticotropic hormone-secreting pituitary adenoma. Patients may present clinical symptoms such as moon face, buffalo back, central obesity and metabolic disorders due to the persistence of hypercortisolemia. Accurate diagnosis, appropriate treatment and follow-up of Cushing's disease are vitally important. Based on recent evidence, the Pituitary Society published the Consensus on Diagnosis and Management of Cushing's Disease: a Guideline Update in December 2021, with updates in screening and diagnosis procedures, postoperative monitoring, medical therapies and radiotherapy, and complication management. This article interprets the medical therapies recommended in the consensus, which will be helpful for general practitioners and specialists to standardize the diagnosis and treatment of Cushing's disease.

Interpretation of ESE Clinical Practice Guideline on Functioning and Non-functioning Pituitary Adenomas in Pregnancy

DENG Chenqian, BAN Jiangli, CHEN Shuchun

2022, 25(36):  4491-4495.  DOI: 10.12114/j.issn.1007-9572.2022.0436

Asbtract ( )   HTML ( )   PDF (2363KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Pituitary adenomas usually cause damage to the gonadal axis, leading to a decrease in fertility in female patients. As pituitary gland enlarges during pregnancy, the hormone secretion of the gonadal axis changes accordingly. Therefore, it is particularly important to standardizedly manage pregnant women with pituitary adenomas. To this end, the European Society of Endocrinology (ESE) published Clinical Practice Guideline on Functioning and Non-functioning Pituitary Adenomas in Pregnancy in August 2021, which details the timing and methods selection of diagnosis and treatment of pituitary adenomas from preconception to postpartum in terms of size, location, and endocrine function of adenomas. We interpreted this guideline and summarized its main points, with a view to providing practical guidance for Chinese clinicians to manage such patients based on relevant clinical evidence and patient characteristics in China.

Article

Association of Baseline Geriatric Nutritional Risk Index and Clinical Outcome of Endovascular Therapy in Patients with Diabetic Foot and Lower Extremity Arterial Disease

WU Wenxia, CHEN Guishan, LIU Xingzhou, YOU Lili, LIU Dan, YAN Li

2022, 25(36):  4496-4501.  DOI: 10.12114/j.issn.1007-9572.2022.0470

Asbtract ( )   HTML ( )   PDF (2214KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Patients with diabetic foot undergoing endovascular therapy for lower extremity arterial disease exhibit poor outcomes and a high mortality rate. It is unclear whether malnutrition assessed by geriatric nutritional risk index (GNRI) is associated with clinical outcomes in these patients.

Objective

To investigate the association of baseline malnutrition assessed by GNRI and clinical outcomes of endovascular therapy for lower extremity arterial disease in patients with diabetic foot.

Methods

Ninety-five patients who were admitted in Department of Endocrinology, Sun Yat-sen Memorial Hospital due to diabetic foot and lower extremity arterial disease were included from January 2011 to December 2016. All of them received endovascular therapy and followed up for two years. Baseline GNRI was assessed, and divided into three levels: normal nutrition (43 cases) , mild malnutrition (31 cases) and moderate to severe malnutrition (21 cases) . Clinical characteristics were collected, including sex, age, diabetes duration, smoking, body mass index, prevalence of cardiovascular and cerebrovascular diseases, diabetic foot classification, systolic and diastolic blood pressure, and blood test results containing white blood cell count, platelet count, lymphocyte count, neutrophil count, neutrophil-to-lymphocyte ratio, hemoglobin, fasting blood glucose, glycosylated hemoglobin, total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, albumin, creatinine, and estimated glomerular filtration rate. The primary endpoint was all-cause mortality, and the secondary endpoint was major lower extremity amputation. The Kaplan-Meier curve was used for survival analysis. Univariate and multivariate Cox proportional hazards regression analysis were analyzed to evaluate the risk factors of all-cause mortality.

Results

Fifty-two cases (54.7%) were assessed with malnutrition (GNRI≤98) . Normal nutrition, mild malnutrition, and moderate to severe malnutrition patients had significant differences in average body mass index, leukocyte count, neutrophil count, neutrophil-to-lymphocyte ratio, hemoglobin, triglyceride and albumin (P<0.05) . During the follow-up, 16 patients died, 10 of whom were due to cardiovascular or cerebrovascular diseases; five patients underwent major lower extremity amputation. The two-year survival rate was 92.1%, 75.6% and 50.1% in normal nutrition, mild malnutrition, and moderate to severe malnutrition patients, respectively, showing statistically significant difference (Log-rank test: χ²=10.812, P=0.004) . GNRI≤98〔HR=3.937, 95%CI (1.070, 13.942) , P=0.037〕 was an independent risk factor for all-cause mortality.

Conclusion

The two-year survival rate of patients in normal nutrition group (GNRI>98) was higher than that in malnutrition group (GNRI≤98) . Baseline GNRI-assessed malnutrition may be an independent risk factor for all-cause mortality in diabetic foot patients with lower extremity arterial disease treated by endovascular therapy, so assessing and improving the nutritional status may better improve the clinical outcome of these patients.

Diagnostic Efficacy of New ECG Criteria for Left Ventricular Hypertrophy in Overweight and Obese Patients with Hypertension

YANG Tao, ZHANG Yongjun, ZHENG Liang, GE Xuhua

2022, 25(36):  4502-4508.  DOI: 10.12114/j.issn.1007-9572.2022.0446

Asbtract ( )   HTML ( )   PDF (2827KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The new electrocardiogram (ECG) criteria have higher accuracy in the diagnosis of left ventricular hypertrophy (LVH) in general population with hypertension than traditional ECG voltage criteria. However, the diagnostic efficacy of new ECG criteria for LVH in overweight and obese patients with hypertension has been rarely reported.

Objective

To explore the diagnostic value of new ECG indicators for LVH in overweight and obese patients with hypertension.

Methods

A retrospective design was used. A total of 368 overweight and obese patients with hypertension were recruited from the First Affiliated Hospital of Wannan Medical College from December 2017 to December 2020, and divided into LVH (+) group (including males with LVH>115 g/m² and females with LVH >95 g/m²) and LVH (-) group (including males with LVH≤115 g/m² and females with LVH≤95 g/m²) . General data were collected and compared between two groups. Intergroup comparison was also performed in terms of ultrasonic cardiography (UCG) indicators〔diastolic interventricular septal thickness (IVST) , left ventricular posterior wall thickness (LVPWT) , left ventricular mass (LVM) , left ventricular mass index (LVMI) , left ventricular ejection fraction (LVEF) 〕and ECG indicators〔QRS duration (QRSd) , corrected QT interval (QTc) , Sokolow-Lyon voltage criteria, Cornell voltage criteria, Peguero Lo-Presti voltage criteria, Cornell product〕with the accuracy of UCG indicators as the gold standard. Binary Logistic regression model was used to analyze the influencing factors of LVH in hypertension with overweight or obesity. ROC analysis was used to evaluate the diagnostic efficacy of new ECG indicators (Sokolow-Lyon voltage criteria, Cornell voltage criteria, Peguero Lo-Presti voltage criteria, Cornell product) for LVH in hypertension with overweight or obesity.

Results

There were statistically significant differences in sex ratio, mean age, body surface area (BSA) , SBP, DBP, β-blocker utilization rate and blood pressure control between LVH (+) and LVH (-) groups (P<0.05) . The mean values of IVST, LVPWT, LVM, LVMI, QRSd, QTc, Sokolow-Lyon voltage criteria, Cornell voltage criteria, Peguero Lo-Presti voltage criteria and Cornell product in LVH (+) group were higher than those in LVH (-) group (P<0.05) . The mean LVEF value in LVH (+) group was lower than that in LVH (-) group (P<0.05) . Age 〔OR=1.046, 95%CI (1.024, 1.069) 〕 and Sokolow-Lyon voltage criteria〔OR=1.793, 95%CI (1.305, 2.463) 〕 were influential factors for LVH risk in hypertension with overweight or obesity (P<0.05) . The AUC of Sokolow-Lyon voltage criteria, Cornell voltage criteria Peguero Lo-Presti voltage criteria and Cornell product for LVH diagnosis in hypertension with overweight or obesity was 0.674, 0.695, 0.662 and 0.722, respectively. The AUC of the combined diagnostic model with age, BSA, SBP, DBP, time of the duration of hypertension, QRSd, QTc, Sokolow-Lyon voltage criteria, Cornell voltage criteria, Peguero Lo-Presti voltage criteria, and Cornell product incorporated was 0.846.

Conclusion

In overweight and obese people with hypertension, the Sokolow-Lyon voltage criteria was associated with LVH. Moreover, the new ECG indicator Peguero Lo-Presti voltage criteria was less effective than Cornell product and other traditional ECG indicators in diagnosing LVH. The combined diagnostic model has proven to be with better diagnostic performance for LVH, which is recommended to be used and promoted in primary care settings with relatively unsatisfactory examination conditions.

Influencing Factors of Severity of Functional Dyspepsia after Ischemic Stroke

SHAO Wei, HUANG Mengmeng, HE Dandan, HUANG Fuxin, NIU Hongyue

2022, 25(36):  4509-4514.  DOI: 10.12114/j.issn.1007-9572.2022.0434

Asbtract ( )   HTML ( )   PDF (2113KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Functional dyspepsia (FD) after ischemic stroke belongs to the category of post-stroke gastrointestinal dysfunction, which is prevalent in middle-aged and elderly patients. Stroke patients may differ from the general population in the influencing factors of FD due to their own somatic and psychological changes.

Objective

To investigate the associated factors of the severity of functional dyspepsia after ischemic stroke.

Methods

A total of 180 middle and old aged patients with functional dyspepsia after ischemic stroke were selected from March 2017 to July 2018 in the Department of Acupuncture of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine. A self-designed dyspepsia symptom score scale was used to evaluate the severity of FD during hospitalization. The patients were divided into mild FD group (score≤7, n=115) and moderate-severe FD group (score>7, n=65) according to the dyspepsia symptom score. Patient data were collected through the medical record system, and multivariate Logistic regression were used to explore the influencing factors of functional dyspepsia severity after ischemic stroke.

Results

The FD symptom scores of 180 patients was in the range of 3-12 points, with an average of (7.2±1.7) points. Among them, 115 patients (63.9%) had symptom score≤7 points, and 65 patients (36.1%) had symptom score>7 points. The severity of functional dyspepsia patients with different ages and stroke duration (acute, convalescent, sequelae) was statistically different (P<0.05) . Multivariate Logistic regression analysis showed middle age (43-55 years) 〔OR=3.367, 95% CI (1.399, 8.104) , P=0.007〕and thalamus infarction〔OR=2.111, 95%CI (1.038, 4.290) , P=0.039〕 were the influencing factors of the severity of functional dyspepsia after ischemic stroke.

Conclusion

Age 43 to 55 years and thalamic infarction are risk factors for FD severity in patients with ischemic cerebral infarction, which may be used as a basis to evaluate the development of FD and provide a reference for clinicians for early intervention of FD in patients with ischemic stroke.

Association of Vitamin D Level with Health-related Quality of Life in Community-dwelling Elderly Population

HUANG Xinyi, ZHANG Yili, SUN Kai, LIU Ning, QI Baoyu, GAO Jinghua, XIE Yanming, WEI Xu

2022, 25(36):  4515-4521.  DOI: 10.12114/j.issn.1007-9572.2022.0445

Asbtract ( )   HTML ( )   PDF (2309KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Vitamin D levels decrease with age and are associated with the occurrence of osteoporosis, fractures, falls and muscle weakness that are common in older adults. In addition, its association with quality of life in the elderly has also been increasingly paid attention.

Objective

To investigate the vitamin D level and its correlation with health-related quality of life in the elderly population dwelling in community in Beijing, and to provide decision-making reference for improving the full life-cycle quality of life of this population.

Methods

The data of this study were obtained from the BEYOND research database carried out in Chaoyang District and Fengtai District of Beijing from November 2017 to July 2018. A total of 1 066 elderly people aged ≥ 60 were included for analysis. Clinical information including demographic and socioeconomic characteristics, biochemical markers of bone metabolism, bone mineral density, left and right hand grip strength, sitting test, and history of falls and fractures during 2-year follow-up was collected. According to the level of 25-hydroxyvitamin D〔25 (OH) D〕, the subjects were divided into vitamin D deficient group, vitamin D insufficient group and vitamin D sufficient group, and the EuroQol Five-dimensional Questionnaire (EQ-5D) was used to evaluate the quality of life of the subjects.

Results

Among the 1 066 subjects, 729 (68.39%) were in the vitamin D deficient group, 291 (27.30%) were in the vitamin D insufficient group, and 46 (4.32%) were in the vitamin D sufficient group. Serum levels of procollagen type 1 N-terminal propeptide (P1NP) , alkaline phosphatase (ALP) , parathyroid hormone (PTH) , osteocalcin (OST) , and cross-linked type I collagen carboxyl-terminal peptide (β-CTX) , left hip overall T value, right hip overall T value, and left hand grip strength were statistically significant among three groups (P<0.05) . There were significant differences in pain discomfort dimension and EQ-5D utility value among the three groups (P<0.05) . The EQ-5D utility value of vitamin D sufficient group was higher than that in both vitamin D deficient group and vitamin D insufficient group (P<0.05) . The results of multiple linear regression analysis showed that 25 (OH) D level was an influence factor of EQ-5D utility value in the elderly (P<0.05) .

Conclusion

The prevalence of vitamin D deficiency and insufficiency in the elderly in the community in Beijing was 68.39% and 27.30%, respectively. The level of vitamin D is positively correlated with bone mineral density, grip strength and EQ-5D total utility value in the elderly. Early screening of vitamin D levels in the elderly population and timely supplementation with adequate intakes are of great significance to maintain and improve the health-related quality of life in the population.

Risk Assessment of Ischemic Cardiovascular Disease in Rural Naxi Population in Low-to-high Altitudes

TANG Zhaoyun, HE Yang, CHEN Cong, YANG Xiaodan, WU Xinhua, LIU Hong

2022, 25(36):  4522-4527.  DOI: 10.12114/j.issn.1007-9572.2022.0402

Asbtract ( )   HTML ( )   PDF (2182KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Cardiovascular disease is a leading cause of death and disability worldwide. There is still a lack of research reports on the risk assessment of cardiovascular disease in rural populations in Naxi, an area in low-to-high altitudes (1 000-3 500 meters) .

Objective

To investigate the exposure and aggregation of cardiovascular disease risk factors, and to assess the 10-year risk of ischemic cardiovascular disease (ICVD) in rural population aged 35-75 years in Naxi area of Yunnan's Lijiang City from August to September 2020.

Methods

By use of random sampling, 35-75-year-old Naxi people were selected from 8 villages in Yunnan, and received a questionnaire survey, physical examination and laboratory examination. The 10-year ICVD risk was used to assess the modified 10-year ICVD risk Scale in Chinese Adults, and statistically analyzed.

Results

A total of 381 cases were included. Individuals from high altitudes had higher systolic blood pressure and triacylglycerol (TG) , and lower total cholesterol (TC) , low-density lipoprotein cholesterol (LDL-C) , and fasting blood glucose than those from moderate altitudes (P<0.05) . The exposure prevalence of hypertension, diabetes, smoking, dyslipidemia, overweight and obesity was 48.8%, 4.7%, 24.7%, 57.7%, and 29.1%, respectively. The smoking prevalence in men was significantly higher than that in women (P<0.01) .The exposure prevalence of hypertension and abnormal body weight increased with age (P<0.05) . Individuals from high altitudes had higher exposure prevalence of hypertension and lower exposure prevalence of diabetes than those moderate altitudes. There were 29.1%, 33.6%, and 21.5% of the participants with 1, 2, and 3 ICVD risk factors respectively. There was significant difference in ICVD risk factors clustered in different gender and age (P<0.05) .The absolute 10-year risk of ICVD in men was higher than that in women (P<0.05) . The absolute 10-year risk of ICVD differed significantly by age in both men and women (P<0.05) .

Conclusion

The 10-year risk of ICVD in 35-75-year-old rural Naxi people was high. Future prevention and treatment of cardiovascular diseases should focus on male and elderly groups.

Association of Therapeutic Effects on Psychological Status of Post-bariatric Patients One Year after Surgery

ZHAO Kang, XU Xinyi, ZHU Hanfei, LIANG Hui, YANG Ningli, LIN Rui, XU Qin

2022, 25(36):  4528-4536.  DOI: 10.12114/j.issn.1007-9572.2022.0463

Asbtract ( )   HTML ( )   PDF (2973KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Bariatric surgery is the effective treatment for obesity, however, the effect of surgery on patients' psychological status is still unclear.

Objective

To investigate the treatment effects of bariatric surgery on patients' psychological status one year after the surgery.

Methods

This is a retrospective cross-sectional study. This study selected 172 patients who underwent bariatric surgery in the department of general surgery, First Affiliated Hospital of Nanjing Medical University during June 2019 to June 2020, and collected their clinical data. The indicators of the treatment effects of bariatric surgery include body composition indicators〔Weight, Body mass index (BMI) , Percentage of excess weight loss (EWL%) , Body muscle mass (BM) , Body fat mass (BF) , Visceral fat (VSF) , metabolism-related biochemical indexes〔Alanine aminotransferase (ALT) , Aspartate aminotransferase (AST) , Total protein (TP) , Albumin (ALB) 〕, preoperative comorbidities, relief of comorbidities after surgery, postoperative complications, postoperative complaints, surgery methods; Indicators of the postoperative psychological status include quality of life, perceived stress, general well-being and satisfaction degree of surgery. This study used the12-item Short Form Survey (SF-12) , Chinese version of the Perceived Stress Scale (CPSS) , General Well-being Schedule (GWS) , Questionnaire of Bariatric Surgery Patient' Satisfaction Survey to investigate the psychological status. This study used the Pearson correlation analysis and Spearman rank correlation analysis to explore the correlation between body composition indicators and metabolic-related biochemical indexes and postoperative psychological status, used the multivariate linear regression analysis to explore the factors that affect postoperative psychological status.

Results

One year after surgery, EWL% was (82.7±31.7) %, and BMI decreased by (10.3±4.3) kg/m². 96 patients (55.8%) had metabolic-related comorbidities such as type 2 diabetes mellitus, hypertension, fatty liver before surgery, 48 patients (27.9%) achieved complete remission, 30 patients (17.4%) achieved partial remission, and 18 patients (10.5%) had no remission after surgery. Patients'weight, BMI, BM, BF, VSF, ALT, AST were lower than those before surgery, the TP and ALB were higher than those before surgery (P<0.05) .The correlation analysis showed that patients' MCS scores were negatively correlated with ΔALT (r_s=-0.160, P=0.036) ; the CPSS scores were negatively correlated with EWL% (r=-0.181, P=0.017) and ΔBM% (r_s=-0.174, P=0.022) but positively correlated with ΔALT (r_s=-0.236, P=0.002) ; the GWS scores were negatively correlated with ΔALT (r_s=-0.228, P=0.003) and ΔAST (r_s=-0.216, P=0.004) ; the satisfaction of surgery were negatively correlated with ΔBMI (r=-0.171, P=0.025) , ΔBF% (r=-0.174, P=0.022) and ΔVSF (r=-0.154, P=0.043) but positively correlated with EWL% (r=0.284, P<0.001) . The multivariate linear regression analysis showed that postoperative stomachache (β=-0.239, P=0.002) and postoperative fatigue (β=-0.169, P=0.025) were factors that affect PCS scores; ΔALT (β=-0.181, P=0.017) and postoperative fatigue (β=0.171, P=0.024) were factors that affect MCS scores; EWL% (β=-0.188, P=0.010) , ΔBM% (β=-0.146, P=0.047) , ΔALT (β=0.219, P=0.003) and postoperative fatigue (β=0.169, P=0.022) were factors that affect CPSS scores; ΔALT (β=-0.254, P=0.001) and acid reflux (β=-0.251, P=0.001) were factors that affect GWS scores; ΔBMI (β=-0.245, P=0.010) , EWL% (β=0.247, P=0.003) and ΔBF% (β=-0.366, P<0.001) were factors that affect satisfaction of surgery. Among the 96 patients with preoperative comorbidities, multiple linear regression analysis showed that postoperative relief of comorbidities (β=0.411, P<0.001) and stomachache (β=-0.192, P=0.040) were factors that affect PCS scores; ΔALT (β=-0.273, P=0.006) and acid reflux (β=-0.263, P=0.008) were factors that affect MCS scores; postoperative relief of comorbidities (β=-0.220, P=0.024) , ΔALT (β=0.301, P=0.002) , stomachache (β=0.214, P=0.023) and ΔVSF (β=0.212, P=0.031) were factors that affect CPSS scores; postoperative relief of comorbidities (β=0.290, P=0.002) , ΔALT (β=-0.310, P=0.001) and stomachache (β=-0.271, P=0.004) were factors that affect GWS scores; postoperative relief of comorbidities (β=0.402, P<0.001) , ΔBF% (β=-0.452, P<0.001) and ΔBMI (β=-0.364, P<0.001) were factors that affect satisfaction of surgery.

Conclusion

Patients' BMI decreased significantly one year after bariatric surgery. The postoperative acid reflux, stomachache, fatigue and the increase of ΔBF% and ΔALT negatively affect patients'psychological status; the increase of EWL% and ΔBM% positively affect patients'psychological status. For patients with comorbidities, the higher the degree of postoperative comorbidity remission, the greater the positive impact on the patient's psychological status.

Curative Effect of Patient-controlled Intravenous Analgesia with Hydromorphone, Sufentanil or Morphine in Treatment of Refractory Cancer Pain with Dysphagia

ZENG Yuan, WANG Guohua, YANG Yong

2022, 25(36):  4537-4545.  DOI: 10.12114/j.issn.1007-9572.2022.0430

Asbtract ( )   HTML ( )   PDF (2770KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Patients with refractory cancer pain often have dysphagia, which increases the difficulty of treatment. Patient-controlled intravenous analgesia (PCIA) is a measure that can achieve sustained, effective and safe analgesia.

Objective

To investigate the efficacy and safety of PCIA with hydromorphone, sufentanil or morphine in treatment of refractory cancer pain with dysphagia.

Methods

A total of 102 patients with refractory cancer pain and dysphagia were selected from Department of Oncology and Hospice Care Center of the Second Hospital of Wuhan Iron and Steel (Group) Corporation from May 2020 to January 2022, and equally divided into hydromorphone PCIA group, sufentanil PCIA group and morphine PCIA group single-blindly and randomly. The Numerical Rating Scale (NRS) score, the frequency of episodes of breakthrough pain, the Morphine Equivalent Daily Dose (MEDD) , Pittsburgh Sleep Quality Index (PSQI) score, Cancer Quality of Life Questionnaire Core 30 (QLQ-C30) score and the incidence of adverse reactions were compared among the three groups before and after treatment.

Results

The participants included 51 males and 51 females, with an average age of (60.2±6.3) years. There were no statistical differences in sex ratio, average age, degree of pain, NRS score, MEDD, distribution of primary cancer type, pain type and TNM classification of cancers among the three groups (P>0.05) . The NRS score and the frequency of episodes of breakthrough pain in three groups deceased significantly after treatment (P<0.05) . The type and time of treatment had interactive effects on both the NRS score and the frequency of episodes of breakthrough pain (P<0.05) . The type of treatment produced main effect on the NRS score and the frequency of episodes of breakthrough pain, so did the time of treatment (P<0.05) . The NRS score and the frequency of episodes of breakthrough pain of hydromorphone PCIA group were significantly lower than those of each of other two groups after 24 hours or 72 hours of treatment (P<0.05) . Morphine PCIA group had higher NRS score than other two groups (P<0.05) , and had higher frequency of episodes of breakthrough pain than hydromorphone PCIA group (P<0.05) after one-week treatment. Morphine PCIA group had higher NRS score and frequency of episodes of breakthrough pain than each of other two groups after two-week or one-month treatment (P<0.05) . After one-month treatment, all groups demonstrated increased MEDD and decreased PSQI (P<0.05) . In particular, morphine PCIA group had higher MEDD than other two groups (P<0.05) . Sufentanil PCIA group had higher MEDD than hydromorphone PCIA group (P<0.05) . Morphine PCIA group had higher PSQI score than other two groups (P<0.05) . All groups demonstrated increased score of each item of the QLQ-C30 (P<0.05) . In particular, morphine PCIA group ranked bottom in terms of the score of each item of the QLQ-C30 (P<0.05) . The emotional function score of sufentanil PCIA group was significantly lower than that of hydromorphone PCIA group (P<0.05) . The incidence of adverse reactions had no significant differences among the three groups after one-month treatment (P>0.05) .

Conclusion

For patients with refractory cancer pain and dysphagia, hydromorphone and sufentanyl were superior to morphine for PCIA in terms of reducing pain and the frequency of episodes of breakthrough pain, improving quality of sleep and life. But hydromorphone was superior to sufentanyl in quick onset, and effective improvement of emotion with reduced dose of opioid and without increased incidence of adverse reactions.

A Comparative Study of Event-related Potential N400 between Anxious and Melancholic Depression

DU Yeming, ZHANG Yunqiao, HAN Min, WANG Yanfang

2022, 25(36):  4546-4553.  DOI: 10.12114/j.issn.1007-9572.2022.0351

Asbtract ( )   HTML ( )   PDF (2693KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

There are many subtypes of major depressive disorder (MDD) . Evidence about the differentiation of them is mostly based on symptomatological characteristics, but rarely by objective biological indicators.

Objective

To explore the differences in event-related potential (ERP) N400 between patients with different subtypes of depression, providing an objective electrophysiological basis for subtyping depression.

Methods

Two hundred and nine outpatients and inpatients who met the diagnostic criteria of MDD in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition were selected from First Hospital of Shanxi Medical University from February 2019 to December 2021, including 78 with anxious depression (ASD+MD-) , 46 with melancholic depression (ASD-MD+) , 61 with anxious and melancholic depression (ASD+MD+) , and 24 with non-anxious and melancholic depression (ASD-MD-) subtyped using the 30-item Inventory of Depressive Symptomatology (IDS-30) and 17-item Hamilton Depression Rating Scale (HAMD-17) . Thirty-five community-living health volunteers were recruited as controls at the same time.The factor and total scores of the HAMD-17 and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) of all subjects were collected. And the latency and amplitude of N400 component of all subjects were collected by inducing N400 components through understanding ambiguous words at the end of sentences.

Results

(1) The total score and factor scores of HAMD-17 differed significantly across MDD subgroups and control group (P< 0.05) . The total score of HAMD-17 in each of the four MDD subgroups was much higher than that in control group (P<0.05) . ASD+MD+ subgroup had significantly higher total score of HAMD-17 than both ASD-MD- and ASD-MD+ subgroups (P<0.05) .ASD+MD- subgroup had significantly higher total score of HAMD-17 than ASD-MD+ subgroup (P<0.05) . The score of anxiety factor in each of the four MDD subgroups was obviously higher than that in control group (P<0.05) . ASD+MD- subgroup had obviously higher score of anxiety factor than both ASD-MD+ and ASD-MD- subgroups (P<0.05) .ASD+MD+ subgroup had prominently higher score of anxiety factor than both ASD-MD+ and ASD-MD- subgroups (P < 0.05) . The score of body weight factor in ASD+MD+ or ASD+MD- subgroup was much higher than that in control group (P<0.05) .ASD+MD+ subgroup had much higher score of body weight factor than both ASD-MD- and ASD-MD+ subgroups (P<0.05) . The score of cognitive impairment factor in each of the four MDD subgroups was much higher than that in control group (P<0.05) .ASD+MD+ subgroup had much higher score of cognitive impairment factor than ASD-MD+ subgroup (P<0.05) . The scores of block factor and sleep disturbance factor in each of the four MDD subgroups were significantly higher than those in the control group (P<0.05) . (2) The total score and factor scores of RBANS varied significantly across four MDD subgroups and control group (P<0.05) .The total score of RBANS and scores of its factors of immediate memory, visual span, speech function, attention, and delayed memory in each of the four MDD subgroups were much lower than those in the control group (P<0.05) . The score of immediate memory factor in ASD+MD+ group was notably lower than that in ASD-MD+ group (P<0.05) . (3) There were no significant differences in latency and amplitude of N400 component across four MDD subgroups and controls (P>0.05) .There were no significant differences in latency and amplitude of N400 component across different electrode sites (P>0.05) , and there were no interaction between no-depression or each of the four subtypes of MDD and electrode sites (P>0.05) . (4) The N400 amplitude value at Fz electrode was negatively correlated with the cognitive impairment factor score (r=-0.170, P=0.016) .The N400 amplitude value at Cz electrode was positively correlated with the block factor score (r=0.151, P=0.033) .The N400 amplitude valueat Pz electrode was positively correlated with the block factor score (r=0.174, P=0.014) .The N400 amplitude value of the Fz electrode was positively correlated with the immediate memory score (r=0.138, P=0.050) .The N400 latency value at Cz electrode was negatively correlated with the delayed memory score (r=-0.155, P=0.028) .

Conclusion

Extensive cognitive impairment was found in MDD patients, including impaired immediate memory, speech function, attention and delayed memory. ASD+MD+ and ASD+ MD-patients had more severe symptoms, and ASD+MD+ patients had the most severe cognitive impairment. N400 amplitude value was negatively correlated with cognitive impairment and positively correlated with block factor in MDD patients. But these patients demonstrated no impaired function of speech integration induced by ambiguous words at the end of sentences.

Investigation and Analysis

Co-prevalence of Substance Use Disorders and Common AxisⅠDisorders in Yunnan's Drug Users

ZHANG Guanbai, ZHENG Ling, YANG Liping, ZHOU Qin, WANG Fei, HE Liangze, CHENG Xuan, CHA Li, LI Xinyue

2022, 25(36):  4554-4560.  DOI: 10.12114/j.issn.1007-9572.2022.0426

Asbtract ( )   HTML ( )   PDF (2532KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Mental disorders in drug users have received increasing attention. However, there are no any epidemiologic data available in regard to substance use disorders (SUD) and other mental disorders in drug users in Yunnan, one region that is hit hardest by epidemic of drug use in China.

Objective

To investigate the co-prevalence of SUD and a common mental disorder, axisⅠdisorders, among Yunnan's drug users.

Methods

A cross-sectional survey was conducted among a convenient sample of 598 male drug users who received detoxification treatment from the 5th Compulsory Detention and Forced Detoxification Center of Yunnan Province and Dali Compulsory Detention and Forced Detoxification Center between August and November, 2020. According to the diagnosis of SUD, the participants were divided into three groups: opioid use disorder group (n=245) , methamphetamine use disorder group (n=197) and double use disorder group (n=146) . The Chinese version of SCID-Ⅰ/P was used to assess the prevalence of common axisⅠmental disorders (psychosis disorder, affective disorder, alcohol use disorder, and sedative-hypnotic use disorder) . The lifetime prevalence of these disorders among the three groups was compared.

Results

Among the 598 cases, there were 588 cases diagnosed with SUD (opioid, methamphetamine, or both) . The lifetime prevalence of psychosis disorder, alcohol use disorder, sedative and hypnotic use disorder among the three groups was significantly different (P < 0.05) . The overall lifetime prevalence of schizophrenia, other primary and drug induced psychotic disorders was 15.82%. The lifetime prevalence of psychotic disorder in opioid use disorder group (5.31%) was lower than that of methamphetamine use disorder group (20.30%) or that of double use disorder group (27.40%) (P<0.05) . The overall lifetime prevalence of affective disorders was 21.77%. To be specific, the lifetime prevalence of affective disorders was 17.14% in opioid use disorder group, 25.38% in methamphetamine use disorder group, and 24.66% in double use disorder group. The overall lifetime prevalence of alcohol use disorder was 42.18%. Specifically, opioid use disorder group had lower lifetime prevalence of alcohol use disorder than methamphetamine use disorder group (35.10% vs 45.69%) and than double use disorder group (35.10% vs 49.32%) (P<0.05) . The overall lifetime prevalence of sedative or hypnotic use disorder was 13.61%. The lifetime prevalence of sedative or hypnotic use disorder was 19.18%, 22.60% and 0 in opioid use disorder group, double use disorder group, and methamphetamine use disorder group, respectively.

Conclusion

The prevalence of the above-mentioned mental disorders in drug users in Yunnan Province was much higher than that in the general population. Moreover, these mental disorders may be even more prevalent in methamphetamine use disorder population than in opioid use disorder population.

Trend Analysis of Life Expectancy and Disease Spectrum in Residents of Jing'an District in Shanghai, 2016-2021

CHU Xiaoting, YANG Xiaoming, WAN Qiuping, ZHANG Guohui, XIONG Jianjing, FANG Jialie

2022, 25(36):  4561-4566.  DOI: 10.12114/j.issn.1007-9572.2022.0381

Asbtract ( )   HTML ( )   PDF (2574KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

As socioeconomic status and population health develop, death patterns and disease spectrum have changed. The impact of diseases on life expectancy have changed as well.

Objective

To analyze the change in life expectancy and disease spectrum in residents of Jing'an District in Shanghai from 2016 to 2021.

Methods

Population data and mortality data of permanent residents in Jing'an District of Shanghai from 2016 to 2021 were collected from the Public Security Bureau of Jing'an District, and the Jing'an District Mortality Surveillance System. The ICD-10 was used to categorize the underlying causes of death. The Abridged Life Tables and Arriaga's decomposition method were used to analyze the impacts of age groups and causes of death on life expectancy.

Results

The life expectancy of these residents from 2016 to 2021 ranged from 83.68 to 84.40 years, which increased by 0.72 years in 2021 compared with that of 2016. The life expectancy of male residents was 81.47 to 82.15 years, demonstrating an increase of 0.68 years during the period. The life expectancy was 85.95 to 86.74 years for female residents, showing an increase of 0.79 years during the period. The decrease of mortality rate in 65 to 84 age group contributed 83.29% to the increase of the life expectancy (0.60 years) , while the decrease of mortality rate in 15 to 44 age group contributed -17.18% to the increase of the life expectancy (-0.12 years) . The largest contribution to the increase of life expectancy was the mortality reduction in cancer, followed by that in respiratory disease, which contributed 56.20% and 53.55%, respectively. The largest contribution to the decrease of life expectancy was increased mortality due to injuries and poisoning, followed by that due to endocrine, nutritional and metabolic diseases, which contributed -35.69% and -17.25%, respectively.

Conclusion

The life expectancy of residents in Jing'an District from 2016 to 2021 was 83.68 to 84.40 years, seeing an increase of 0.72 years. The increase of life expectancy was mainly attributed to the decrease of mortality in 65 to 84 age group and the decrease of mortality due to cancer. However, the increase of mortality due to injuries and poisoning had negative contribution.

Diagnosis and Treatment

Ultrasonographic Findings and Clinical Diagnosis of Large Placental Lake-like Lesions: Clinical Analysis of Six Cases

XUAN Yinghua, WANG Li, HUANG Ruizhen, WU Qingqing

2022, 25(36):  4567-4572.  DOI: 10.12114/j.issn.1007-9572.2022.0411

Asbtract ( )   HTML ( )   PDF (3224KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Objective

To discuss prenatal ultrasonographic characteristics of placental lake-like lesions and the significance of prenatal diagnosis of these lesions.

Methods

Six patients with prenatal placental lake-like lesions (maximal diameter>5 cm) detected by ultrasound were selected from Beijing Obstetrics and Gynecology Hospital, Capital Medical University from February 2016 to December 2021. Their demographic data, ultrasound features, clinical diagnoses and pregnancy outcomes were retrospectively analyzed.

Results

All the patients had a singleton pregnancy, aged 27-33 years at diagnosis, and were initially found with placental lake-like lesions at 18 weeks and two days of pregnancy to 31 weeks and 6 days of pregnancy. Lake-like lesions with clear margins with placenta were detected by ultrasound in cases 1, 2 and 3, all of them were clinically diagnosed with massive subchorionic hematoma (MSH) , then underwent ceserean section at less than 34 weeks but greater than 33 weeks of pregnancy, less than 30 weeks but greater than 29 weeks of pregnancy, and 32 weeks of pregnancy, respectively, and all of 3 neonates had hypospadias. In case 4, a lake-like lesion with definite border protruding into amniotic cavity was found, which spontaneously disappeared in minutes. Fetal growth was unremarkable during pregnancy. In follow-up, the lesion was decreased significantly. Final diagnosis was real large placental lake. In cases 5 and 6, lake-like lesions diffusely involved most part of placenta, with decreased normal placental tissues. Both cases were complicated by early-onset fetal growth restriction (all biometric parameters<1%, abdominal circumference 2.3%) . Absence of diastolic flow in umbilical artery and notches in uterine arteries (bilateral, unilateral) were found in ultrasound examinations in both cases. Case 5 chose to terminate pregnancy at 23 weeks of pregnancy, and case 6, who was also complicated by preeclampsia, terminated pregnancy at less than 28 weeks but greater than 27 weeks of pregnancy. Clinical diagnosis for both of them was maternal vascular malperfusion (MVM) with early-onset FGR.

Conclusion

Placental lake-like lesions can be caused by different etiologies. Each type can be differentiated according to ultrasound characteristics. Timely prenatal diagnosis by ultrasound will benefit close monitoring of fetal status in MSH and MVM cases to prevent negative pregnancy outcomes.

Lumbar Discitis Due to Intrauterine Purulent Infection Induced by Removing the Intrauterine Contraceptive Ring: a Case Report and Literature Review

YANG Yanyan, WANG Xinling, LI Na, WANG Bei, DUAN Xiaoyan, ZHANG Yunxia

2022, 25(36):  4573-4577.  DOI: 10.12114/j.issn.1007-9572.2022.0403

Asbtract ( )   HTML ( )   PDF (2269KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Intrauterine purulent infection is a severe pelvic inflammatory disease, which manifests as fever, abdominal pain, and increased vaginal secretions. Discitis is an infectious disease which may both affect the intervertebral disc space and the adjacent vertebrae or cartilage plate. Due to the absence of typical symptoms and signs, the clinical diagnosis of this disease may be delayed until damaged pyramidal bone and decreased lower-limb muscle strength. We reported a case of lumbar discitis caused by intrauterine purulent infection after removing the intrauterine contraceptive ring, presenting with low back pain with walking disorder, then conducted a literature review to deepen the understanding of the pathogens, routes of infection transmission, diagnostic criteria, treatment principles and serious adverse consequences of pelvic inflammatory disease. For nonspecific intervertebral discitis, clinicians should carefully ask for the medical history and the progression of the disease, in addition to laboratory and imaging tests. It is especially important to make a diagnosis and perform the surgery in time.

The Checklist of Abdominal Pain Causes Used in the Differential Diagnosis of Vascular Diseases with Abdominal Pain as a Presentation: an Analysis of Three Cases

WANG Cuiya, ZHANG Junna, ZANG Huiling, LYU Chang, GUO Hui, MA Zhichao, LI Jianguo

2022, 25(36):  4577-4581.  DOI: 10.12114/j.issn.1007-9572.2022.0298

Asbtract ( )   HTML ( )   PDF (2161KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Acute abdominal pain is one of the most common chief complaints in medical emergencies. Due to atypical clinical manifestations, the misdiagnosis rate of acute abdominal pain caused by vascular diseases is high.

Objective

To assess the value of the checklist of abdominal pain causes in the differential diagnosis of vascular diseases with abdominal pain as a presentation.

Methods

In accordance with the five diseases (localized organic disease, heart, lung and spine diseases, systemic disease, functional disorders, gynecological disease) with abdominal pain as a manifestation in the checklist of abdominal pain causes, we analyzed the causes of abdominal pain in three patients with acute atypical abdominal pain as the main manifestation for making a proper diagnosis, then assessed the practicability of the checklist in the diagnosis of vascular diseases.

Results

With the help of the checklist, the time used for diagnosing one patient with acute renal infarction, one with aortic dissection, and the other with pulmonary embolism was 1.5, 1.5, 1.75 hours, respectively. All the patients received timely diagnosis and treatment.

Conclusion

The checklist is helpful to the differential diagnosis of vascular abdominal pain, making a rapid clinical diagnosis, and forming a systematic diagnostic thinking mode.

Review

Recent Developments in Oral Frailty in the Elderly

PAN Qi, DAI Fumin, PAN Weiyu, LIU Jiamin, CHEN Ruojuan

2022, 25(36):  4582-4587.  DOI: 10.12114/j.issn.1007-9572.2022.0268

Asbtract ( )   HTML ( )   PDF (2427KB) ( )  

References | Related Articles | Metrics

Oral frailty has been recently suggested as a novel construct defined as a decrease in oral function with a coexisting decline in cognitive and physical functions, which is associated with many adverse events in older adults, such as frailty, sarcopenia, disability, and mortality. We reviewed the definition, symptoms, diagnosis criteria, assessment tools of oral frailty in older people, and summarized its recent research status as well as possible influencing factors, then suggested that future research on oral frailty in older Chinese adults could be carried out in aspects involving developing oral frailty assessment tools appropriate for older Chinese people, implementing survey studies on oral frailty, enriching study designs and contents and enhancing oral frailty intervention studies.

Progress in Diagnosis and Treatment of Hyperkalemia with Comorbid Risk Factors

LUO Peiyi, MA Liang, GOU Shenju

2022, 25(36):  4587-4594.  DOI: 10.12114/j.issn.1007-9572.2022.0312

Asbtract ( )   HTML ( )   PDF (2850KB) ( )  

References | Related Articles | Metrics

Hyperkalemia is a common clinical problem, and risk factors for its occurrence include having kidney disease, cardiovascular disease, diabetes, and taking medications that affect serum potassium. Mainly presenting with cardiac and neuromuscular symptoms, it can also lead to serious cardiac arrhythmias. Therapeutically, the choice of drug or dialysis treatment should be guided by the serum potassium level and the severity of clinical manifestations. Multiple novel oral potassium lowering drugs have emerged in recent years, promising to change the treatment paradigm of hyperkalaemia. In this paper, the epidemiology, diagnosis, cause, prevention, and treatment of hyperkalemia associated with comorbid risk factors were reviewed in combination with the literature, in order to provide a theoretical basis for the related diagnosis and treatment of hyperkalemia associated with combined risk factors.

Advances in the Mechanism of Lactobacillus rhamnosus GG Improving Inflammatory Bowel Disease

CEN Qiuyu, PANG Rizhao, CUI Yanru, WEI Juanfang, ZHANG Anren

2022, 25(36):  4595-4600.  DOI: 10.12114/j.issn.1007-9572.2022.0330

Asbtract ( )   HTML ( )   PDF (2594KB) ( )  

Figures and Tables | References | Related Articles | Metrics

China is seeing an increasing prevalence of inflammatory bowel disease (IBD) . During the process of exploring treatments for IBD, gut microbiota has been found to be crucial to the development of IBD along with the discovery of microbial-host interactions, suggesting that modulating gut microbiota may be a new strategy for the treatment of IBD. Recent studies have shown that Lactobacillus rhamnosus GG (LGG) , one most widely used probiotic strain, can achieve IBD alleviation by regulating intestinal microbial composition, maintaining intestinal epithelial barrier integrity, modulating intestinal immune response, inhibiting oxidative stress, and improving anxiety-depression status. Therefore, this paper presents a review of the mechanism of action of LGG in improving IBD, providing theoretical support for its clinical application.

Research Methodology

Test-negative Design: Basic Principles, Methods of Implementation, Types of Derivatives, Advantages, Limitations, and Applications

WU Ting, LIU Jue

2022, 25(36):  4601-4608.  DOI: 10.12114/j.issn.1007-9572.2022.0277

Asbtract ( )   HTML ( )   PDF (3136KB) ( )  

Figures and Tables | References | Related Articles | Metrics

As a simple, rapid and effective research method, test-negative design (TND) has been widely used to support the evaluation of post-marketing effectiveness of vaccines and efficacies of interventions in healthcare institutions, showing a magnificent prospect of application. With the emergence of new derivative types such as real-time TND and cluster-randomized TND, TND has also been gradually applied to the exploration of disease risk factors and effectiveness evaluation of interventions. However, there are still few related research reports in China. We introduced the basic principles, methods and essentials of implementation, newly derivative types such as real-time TND and cluster-randomized TND, advantages and limitations of TND, as well as its applications in assessing post-marketing effectiveness for vaccines and efficacies of interventions, providing a theoretical and practical basis for researchers in China to carry out relevant research.