Table of Content

20 March 2023, Volume 26 Issue 09

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Guide Interpretation

Clinical Interpretation of Physical Activity and Exercise in Peritoneal Dialysis: International Society for Peritoneal Dialysis and the Global Renal Exercise Network Practice Recommendations

YANG Changyuan, LING Xitao, HU Xiaoxuan, ZHANG La, QIN Xindong, LIU Hui, LU Fuhua, SU Guobin

2023, 26(09):  1031-1037.  DOI: 10.12114/j.issn.1007-9572.2022.0713

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Peritoneal dialysis (PD) patients generally have low level of physical activity and poor physical functions. Maintaining good physical function has always been a health concern of PD patients. However, there has been no consensus on how to carry out physical activity/exercise intervention and to maintain good physical function in PD patients. Practice recommendations of Physical Activity and Exercise in Peritoneal Dialysis (hereinafter referred to as PAEPD) , the first global practice recommendations on physical activity and exercise in PD patients, were released by International Society for Peritoneal Dialysis (ISPD) and the Global Renal Exercise Network (GREX) in February 2022. In accordance with the physical activity and exercise in Chinese PD patients, after reviewing the PAEPD and other relevant international recommendations, we performed a clinical interpretation of PAEPD in detail, towards addressing the concerns of clinical healthcare workers and PD patients in China: timing of exercise and activity, and volume of intraabdominal fluid recommended during physical activity, core strengthening, potential symptoms and adverse events related to activity and exercise, and individualized activity and exercise. All this will provide clinical healthcare workers with guidance on the management of physical activity and exercise in PD patients.

Article·Nonspecific Low Back Pain

Identification of Clinical Questions for the Development of Clinical Practice Guideline on Acupuncture and Moxibustion for Nonspecific Low Back Pain Using the Modified Delphi Method

LIU Lanping, YANG Yue, HUANG Man, MA Xiaojing, YE Yongming, LIU Xiaoxu, LIN Huize, ZHU Kexin, GUO Shengnan, FEI Yutong, YANG Tao, YU Jinna

2023, 26(09):  1037-1043.  DOI: 10.12114/j.issn.1007-9572.2022.0816

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Nonspecific low back pain, a common clinical disease, is with high morbidity and prone to recurrent attacks. Clinical practice has proven that acupuncture and moxibustion therapies have positive effects on nonspecific low back pain, and the therapies are various, yet there is a lack of scientific and normative clinical practice guidelines. Identifying clinical questions is the most important step in developing clinical practice guidelines. This paper summarized the process and experience of the successful identification of clinical questions in the development of Clinical Practice Guideline on Acupuncture and Moxibustion for Nonspecific Low Back Pain by the guideline expert panel using the modified Delphi method, hoping to provide a reference for developing acupuncture and moxibustion-related clinical practice guidelines.

Motion Style Acupuncture Can Effectively Improve the Effectiveness of Acute Nonspecific Low Back Pain: a Meta-analysis

FEI Jingwen, LIN Huize, ZHANG Pingping, LIU Lanping, WANG Xiang, SHEN Jianghong, ZHU Kexin, YANG Tao, YU Jinna

2023, 26(09):  1044-1052.  DOI: 10.12114/j.issn.1007-9572.2022.0709

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Background

Many randomized controlled trials (RCTs) about motion style acupuncture in the treatment of acute nonspecific low back pain (ANSLBP) have been published recently, but there is no new systematic evaluation for effectiveness and safety of this treatment in ANSLBP.

Objective

To systematically evaluate the effectiveness and safety of motion style acupuncture in treating ANSLBP by meta-analysis.

Methods

RCTs, crossover studies or cohort studies about effectiveness and safety of motion style acupuncture in treating ANSLBP were retrieved in electronic databases of CNKI, CBM, Wanfang Data, VIP, PubMed, the National Library of Medicine, Embase and the Cochrane Central Register of Controlled Trials from inception to March 25th, 2021. Revman 5.3 was used to complete the Meta-analysis.

Results

All the finally enrolled 17 articles used a design of RCT, including 1 226 patients, and 610 of them were treated with motion style acupuncture (observation group) , and other 616 patients were treated with positive control, blank control, placebo acupuncture or dummy acupuncture (control group) . Meta-analysis showed that, compared with controls treated with Western medicine, the observation group had significantly lower post-treatment VAS score〔MD=-1.54, 95%CI (-2.43, -0.65) , P=0.000 7〕, and Roland-Morris Disability Questionnaire (RMDQ) score〔MD=-3.08, 95%CI (-4.92, -1.24) , P=0.001〕, and significantly higher post-treatment ROM of lumbar vertebra〔MD=-1.42, 95%CI (-1.62, -1.22) , P<0.000 01〕and overall response rate〔RR=1.27, 95%CI (1.19, 1.35) , P<0.000 01〕, but there was no significant difference in post-treatment ODI score between the two groups〔MD=-5.11, 95%CI (-19.12, 8.91) , P=0.48〕. Compared with controls treated with dummy acupuncture, the observation group had significantly lower post-treatment VAS score〔MD=-1.70, 95%CI (-2.05, -1.35) , P<0.000 01〕and RMDQ score〔MD=-3.06, 95%CI (-4.50, -2.70) , P<0.000 01〕. Compared with controls treated with physical therapy, the observation group had significantly lower post-treatment VAS score〔MD=-1.60, 95%CI (-2.06, -1.14) , P<0.000 01〕and RMDQ score〔MD=-3.00, 95%CI (-4.31, -1.69) , P<0.000 01〕. Compared with controls treated with Tuina, the observation group had significantly lower post-treatment VAS score〔MD=-1.50, 95%CI (-1.65, -1.35) , P<0.000 01〕, and significantly higher overall response rate〔RR=1.19, 95%CI (1.09, 1.30) , P=0.000 1〕. Only one RCT reported that the incidence of adverse events in observation group was 13.33% (4/30) during treatment.

Conclusion

Available documentary evidence showed that, motion style acupuncture can effectively relieve the pain and lumbar dysfunction, and improve the ROM of lumbar vertebra and overall response rate in patients with ANSLBP, with high safety, but which still needs to be confirmed by more high-quality, large-sample RCTs.

Outcome Measures Used in Randomized Controlled Trials of Acupuncture for Chronic Nonspecific Low Back Pain

LIN Huize, YAN Wenxi, ZHANG Pingping, FEI Jingwen, SHEN Jianghong, LIU Lanping, WANG Xiang, ZHU Kexin, YANG Tao, YU Jinna

2023, 26(09):  1053-1063.  DOI: 10.12114/j.issn.1007-9572.2022.0711

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Background

As an important treatment for chronic nonspecific low back pain (CNSLBP) , the effect of acupuncture on CNSLBP has been studied by numerous randomized controlled trials (RCTs) with the development of research on acupuncture. However, there are some problems in the selection of outcome indicators, which severely hinder the generation of high-quality clinical evidence.

Objective

To describe the outcome measures used in RCTs of acupuncture for CNSLBP, providing a basis for the carrying out of relevant research.

Methods

Four Chinese databases (CNKI, VIP, Wanfang Data and SinoMed) and three English databases (PubMed, Embase and Cochrane Library) were systematically searched for literature on CNSLBP treated with acupuncture published from January 1, 2017 to March 15, 2022, and the NSLBP core outcome set (COS) used in studies published from database inception to March 15, 2022. According to the enrolment criteria to analyze the following aspects: basic characteristics, classification of clinical outcome indicators, use of composite indicators, and the application of TCM Criteria for Diagnosis and Treatment of Diseases & Syndromes (hereinafter referred to as TCMCDTDS) . In addition, 11 studies published from database inception to March 15, 2022 were enrolled to analyze their basic characteristics and use of COSs of NSLBP. In addition, to analyze the studies' basic characteristics and use of NSLBP COS. The similarities and differences between COSs of NSLBP and outcome measures in the RCTs in recent five years were compared.

Results

Of the included 49 RCTs, four are in English and the other 45 are in Chinese, involving 4 272 cases aged from 18 to 69 years (2 049 in the treatment group, and 2 223 in the control group) . The course of CNSLBP was reported in 38 RCTs. A total of 33 outcome indicators were used in all the RCTs, divided into assessing pain, dysfunction, quality of life, activities of daily living, treatment safety, patient satisfaction, disease recognition, psychological status indicators, and other indicators. The outcome indicator number in one RCT were from 1 to 8. The outcomes were measured twice in 42 RCTs, namely before and after treatment. Safety was reported in only two RCTs. The indicator of "effective rate" in the TCMCDTDS was used in 77.55% (38/49) of the RCTs. The COSs of NSLBP in the aforementioned 11 studies include indicators assessing pain, dysfunction, quality of life, psychological status, social functioning and patient satisfaction. Three of the studies graded the domains of outcome measures in terms of importance, four covered patient satisfaction indicators, five covered psychological assessment indicators, nine used different measurement tools for different outcomes, and one used COSs of NSLBP treated with TCM.

Conclusion

The COSs of NSLBP used in studies and outcome measures in the included RCTs have similarities in the contents involving pain level, dysfunction, quality of life, psychological status and patient satisfaction, and differences in the selection of the type of outcome domain, direction of attention, and measurement tools. The RCTs used both primary and secondary outcome measures, had unclear measurement time points, great heterogeneity in the number of used outcome measures, and non-standard application of outcome measures, and valued efficacy outcomes but undervalued safety indicators. In view of this, we put forward the recommendation on the use of outcome measures for future relevant studies: according to the research characteristics, choosing the recognized outcome measures with reference to available COSs of NSLBP and common measurement tools.

Intervention Effect of a Novel Core Stability Rehabilitation Training Program on Chronic Non-specific Low Back Pain

LIU Xiaolong, HE Mengxiao, YIN Yikun, YANG Yang, ZHANG Jingzhi

2023, 26(09):  1064-1074.  DOI: 10.12114/j.issn.1007-9572.2022.0608

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Background

The traditional core stability rehabilitation training has been proven to be effective in improving the rehabilitation in patients with chronic non-specific low back pain (CNSLBP) , but with poor long-term compliance. We independently developed a new core stabilization rehabilitation training program (NO.2021107165452) for CNSLBP patients, but the intervention effects of which are still unclear.

Objective

To explore the intervention effect of a novel core stabilization rehabilitation training program in CNSLBP patients.

Methods

Twenty-one male CNSLBP patients were recruited from Guangxi Normal University and Guilin College from December 2021 to January 2022, and randomly divided into an experimental group (n=11) and a control group (n=10) , receiving a six-week intervention using the core stabilization rehabilitation training program independently developed by our research group, and traditional core stability rehabilitation training, respectively. The visual analogue scale (VAS) was used to evaluate the pain level. The Oswestry Disability Index (ODI) was used to evaluate the status of lumbar dysfunction. The Hoggan MicroFET 2 was used to measure muscle force and muscle force signals of the flexor muscles, extensor muscles, and rotatores muscles of the low back. The Y-balance test (YBT) was used to assess the dynamic balance ability.

Results

The values of VAS and ODI were significantly reduced in both groups after the intervention (P<0.05) , and they were more lower in the experimental group (P<0.05) . The muscle strength of upper abdominal flexors, spinal extensors, spinal left rotators, and spinal right rotators increased significantly in both groups after the intervention (P<0.05) . The left and right YBT scores were increased notably in both groups after the intervention (P<0.05) , and they were more higher in the experimental group (P<0.05) .

Conclusion

Both kinds of intervention programs could improve the lumbar pain, lumbar dysfunction, the muscle strength of upper abdominal flexors, spinal extensors, and spinal rotators, and dynamic balance in CNSLBP patients, but our core stability rehabilitation training program was more effective in reducing lumbar pain, improving lumbar dysfunction, and enhancing dynamic balance, so this novel program is worth promoting.

Article

Influencing Factors of Hypertension Combined with Mild Cognitive Impairment in Community Population over 55 Years

MA Wanrui, LI Manna, WANG Liqun, WANG Zhizhong

2023, 26(09):  1075-1079.  DOI: 10.12114/j.issn.1007-9572.2022.0733

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Background

Hypertension and mild cognitive impairment (MCI) are ordinary health problems in the elderly. The research on the status and risk factors of hypertension complicated with MCI in elderly population in the community is insufficient.

Objective

To inquire into the prevalence of hypertension combined with MCI in urban communities and analyze the possible influencing factors of its comorbidities.

Methods

Five communities with a relatively high proportion of elderly population were selected in Yinchuan City and Wuzhong City of Ningxia Hui Autonomous Region by typical sampling from September to November 2011. A health survey was conducted among all community residents aged≥55 years in the communities. 509 patients with hypertension were included, and multivariate Logistic regression was used to analyze the influencing factors of hypertension patients with MCI. The regression coefficient of each influencing factor was used as the weight to calculate individual predictive risk value, and receiver operating characteristic curve (ROC curve) was drawn to evaluate the predictive value of individual predictive risk value for hypertensive patients with MCI.

Results

The patients were divided into hypertension with MCI group (n=97) and hypertension without MCI group (n=412) according to whether they were combined with MCI. There were statistically significant differences in age distribution, gender, smoking, hypertension grade, depression score, uric acid and albumin between the two groups (P<0.05) . Age≥75 years old〔OR=2.63, 95%CI (1.31, 5.27) 〕, gender〔OR=0.46, 95%CI (0.22, 0.94) 〕, albumin〔OR=0.96, 95%CI (0.91, 0.99) 〕, depression score〔OR=1.06, 95%CI (1.01, 1.10) 〕, hypertension grade 2〔OR=2.12, 95%CI (1.16, 3.89) 〕, hypertension grade 3〔OR=2.38, 95%CI (1.22, 4.66) 〕were the influential factors for hypertensive patients with MCI (P<0.05) . ROC curve analysis results showed that the area under ROC curve of individual predictive risk value predicting hypertensive patients with MCI was 0.72〔95%CI (0.65, 0.78) , P<0.001〕. The optimal cut-off value was 0.18, the sensitivity was 0.69, and the specificity was 0.63.

Conclusion

Community hypertension patients aged 75 years or older, with grade 2 or higher hypertension, with depressive symptoms, and female patients had an increased risk of MCI, screening programs and treatment of hypertension and depression symptoms can be helpful on maintaining cognitive function.

Association of Osteoporosis with Muscle, Bone and Lipid Related Indices

LIN Yanping, GUO Haiwei, HUANG Jiachun, YUAN Jiayao, LIN Xiancan, WAN Lei, HUANG Hongxing

2023, 26(09):  1080-1085.  DOI: 10.12114/j.issn.1007-9572.2022.0578

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Background

As a chronic age-related disease known as "silent killer" in medical academic circle, osteoporosis is manifested by slow and insidious development, and obvious age-related physiological changes in muscle, bone and fat. There are few studies on the relationship of osteoporosis with muscle, bone, and fat indices.

Objective

To assess the relationship of osteoporosis with muscle, bone, and fat indices.

Methods

A total of 108 patients with primary osteoporosis were recruited from the Third Affiliated Hospital of Guangzhou University of Chinese Medicine according to the inclusion and exclusion criteria from July 19, 2019 to January 5, 2021. Data were collected, including general data (height, weight and BMI) , T-score, fat mass, muscle mass and bone mineral content measured by the dual-energy X-ray absorptiometry, bone formation indices, such as serum calcium, bone morphogenetic protein-2 (BMP2) and osteoproteintin (OPG) detected by ELISA. Height, weight, BMI, T-score, fat mass, muscle mass, fat percentage and bone mineral content were compared across three age groups. Fat mass, muscle mass, fat percentage, bone mineral contents and bone formation indices were compared across normal group (T-score≥-1.0, n=20) , bone loss group (-2.5<T-score<-1.0, n=38) and osteoporosis group (T-score ≤-2.5, n=50) divided by the T-score.

Results

The T-score varied significantly in three age groups of 49-58, 59-68, and≥69 (P<0.05) , and it was the highest in the 49-58 age group (P<0.01) . Compared with the normal group, bone loss group had decreased bone mineral content, while osteoporosis group had decreased fat mass and bone mineral content (P<0.05) . Compared with the bone loss group, both the muscle mass and bone mineral content in the osteoporosis group were decreased (P<0.05) . Compared with normal group, a significant decrease was found in OPG and BMP2 in osteoporosis group, and in BMP2 in bone loss group (P<0.05) . Compared with bone loss group, a significant decrease was found in OPG and BCL2 in osteoporosis group (P<0.05) .

Conclusion

The abnormality in dynamic balance between muscular and skeletal systems and adipose tissue is closely related to the pathogenesis of osteoporosis. Bone mineral density decreases with age, decrease in serum BMP2, OPG and Bcl2 levels may be related to the failure of apoptosis-regulatory proteins to play a good role in anti-apoptosis and promoting bone formation, resulting in the decrease of osteoblast activity and the weakening of bone formation activity.

Effects of Exposure to Environmental Factors on Exhaled Nitric Oxide Levels in Patients with Non-acute Exacerbation of Bronchial Asthma

HU Xiaofeng, CAI Guangyun, XIAO Kun, XU Pusheng, YU Chunhong, LIN Haihuan

2023, 26(09):  1086-1091.  DOI: 10.12114/j.issn.1007-9572.2022.0593

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Background

The measurement of exhaled gas nitric oxide (FeNO) has safe, non-invasive, simple, repetitive characteristics which is widely used in the assessment of airway inflammation in asthmatic patients, but the determination of FeNO is affected by a variety of factors, among which living environment factors exposure may have a close relationship to FeNO level, whereas there are few studies on the impact of exposure of living environment factors on the level of FeNO.

Objective

To analyze the effect of exposure to living environment factors on the level of exhaled nitric oxide (FeNO) in patients with bronchial asthma in non acute attack period, so as to improve the efficacy of clinicians in using FeNO to manage asthma.

Methods

A total of 109 patients with bronchial asthma in non acute attack period who visited the Respiratory Department Outpatient of the Second Affiliated Hospital of Guangzhou Medical University from July 2018 to June 2020 were included as the study subjects, the data were collected through a questionnaire survey, and the questionnaire information mainly included general information (gender, age, height, body mass) , living environment factors (including smoking history, whether family members smoked at home, allergy history, location of residence, the distance between the residence and the main road with large traffic volume, whether there were factories around the residence, floors of residential buildings, length of residence building, frequency of washing and drying bed sheets, quilt covers/pillow cases, curtain materials at home, potted plants at home, whether the trash can in the home was cleaned regularly, whether kept pets at home, whether there were cockroaches at home and whether kitchen waste was disposed of the same day, whether there were plush toys at home) and the inspection data of FeNO collected. Patients with bronchial asthma were divided into 3 groups according to FeNO level: there were 47 cases in the FeNO low level group (FeNO<25 ppb) , 35 cases in the FeNO medium level group (25 ppb≤FeNO≤50 ppb) and 27 cases in the FeNO high level group (FeNO>50 ppb) . Ordinal multiple classification logistic regression analysis was used to explore the environmental factors affecting the FeNO value level measurement.

Results

There was no significant difference in gender, age, height and body mass among the three groups (P>0.05) . There was no significant difference among the three groups in floors of residential buildings, length of residence, frequency of washing and drying bed sheets, quilt covers/pillow cases, curtain materials at home, potted plants at home, whether the trash can in the home was cleaned regularly, whether there were cockroaches at home and whether kitchen waste was disposed of the same day, whether there were plush toys at home (P>0.05) ; There were statistically significant differences in smoking history, whether family members smoked at home, allergy history, location of residence, the distance between the residence and the main road with large traffic volume, whether there were factories around the residence, and whether there were pets at home (P<0.05) . Those with a history of smoking were 0.332 (P=0.022) times more likely to have one grade higher FeNO levels compared to those without; Family member smoking at home was 0.345 (P=0.014) times more likely to have one grade higher FeNO level compared to those not smoking at home; Compared with those without pets at home, those who kept pets at home were 0.327 (P=0.014) times more likely to have one grade higher FeNO level; Those with a history of allergy were 4.076 (P=0.003) times more likely to have one grade higher FeNO levels compared to those without; Those whose place of residence was the center of the city were 3. 908 (P = 0.006) times more likely to have one grade higher FeNO level compared with those whose place of residence was suburban; The probability of having one grade higher FeNO level were 2.689 (P=0.018) times higher in those whose place of residence was near the main tract versus those whose place of residence was far from the main tract; Those with a factory around their place of residence were 2.740 (P=0.032) times more likely to have one grade higher FeNO level compared with those without a factory around their place of residence.

Conclusion

The determination of FeNO value level used in daily management of asthma is obviously affected by exposure factors of living environment, especially tobacco exposure, allergies, keeping pets and place of residence, and needs to be differentiated clinically for relevant patients.

Sex-specific Prevalence and Influencing Factors of Hypertension among Nurses: a Propensity Score Matching-based Study

HAO Xiaoran, ZHAO Bin, CUI Wei, LI Jing, LIU Jie, FENG Di, ZHANG Luqi, LI Yun, LI Xian, DING Junqin, LI Laiyou, LI Lanfeng, YIN Xiaohua, LI Yuzhuo, HUANG Xianghe

2023, 26(09):  1092-1103.  DOI: 10.12114/j.issn.1007-9572.2022.0616

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Background

Long-term high level of mental tension induced by nursing work may be associated with increased blood pressure in nurses. The factors influencing hypertension may differ by sex, since there are sex-specific differences in the regulation of blood pressure in molecules, cells and tissues. So exploring influencing factors for hypertension in male and female nurses is significant for formulating targeted prevention and control strategies.

Objective

To examine the prevalence and influencing factors of hypertension among male and female nurses in Hebei Province, providing a basis for developing sex-based hypertension prevention and control measures for nurses.

Methods

A census survey method was used. The prevalence and influencing factors of hypertension were investigated among 128 009 nurses in all hospitals in 11 cities of Hebei Province from November 2016 to July 2018. The recognized factors influencing hypertension were matched between male and female nurses by propensity score matching. Based on the matched data, multivariate Logistic regression was used to explore the factors influencing hypertension among male and female nurses.

Results

The prevalence of hypertension was higher in male nurses than in female nurses〔20.36% (1 115/5 476) vs 6.26% (669/122 533) , P<0.001〕. After propensity score matching, age〔>25-35 years old (OR=2.182) , >35-45 years old (OR=3.560) , >45-55 years old (OR=7.406) , >55-65 years old (OR=13.339) 〕, BMI〔24.0-<28.0 kg/m² (OR=1.591) , ≥28.0 kg/m² (OR=2.739) 〕, location of hospital〔Cangzhou (OR=1.431) , Hengshui (OR=1.834) , Tangshan (OR=1.408) 〕, years of hyperlipidemia〔>0-5 years (OR=3.399) , >5-10 years (OR=4.451) 〕, family history of hypertension (OR=1.225) were influencing factors of hypertension for male nurses (P<0.05) . Age〔>25-35 years old (OR=1.382) , >35-45 years old (OR=4.125) , >45-55 years old (OR=6.510) , >55-65 years old (OR=5.616) 〕, BMI〔24.0-<28.0 kg/m² (OR=1.749) , ≥28.0 kg/m² (OR=3.111) 〕, department〔paediatrics (OR=1.570) , medical technology department (OR=1.779) 〕, years of hyperlipidemia〔>0-5 years (OR=2.863) , >5-10 years (OR=3.713) 〕, years of diabetes〔>0-5 years (OR=3.126) , >5-10 years (OR=2.947) , >10 years (OR=9.743) 〕, family history of hypertension (OR=1.243) , menstrual condition〔irregular (OR=1.358) , menopause (OR=1.689) 〕, pregnancy hypertension〔no (OR=0.486) , no history of pregnancy (OR=0.507) 〕were influencing factors of hypertension for female nurses (P<0.05) .

Conclusion

The prevalence of hypertension was higher in male nurses than in female nurses. Age, BMI, years of hyperlipidemia, and a family history of hypertension are influencing factors of hypertension for both male and female nurses. Working at the pediatric or medical technology department, irregular menstruation, menopause, or gestational hypertension only affected the risk of hypertension in female nurses. These factors associated with hypertension can inform targeted prevention and control measures. In addition, the location of hospital was influencing factors of hypertension only for male nurses.

Predictive Value of Color Doppler Ultrasound for Acute Kidney Injury in Patients with Septic Shock

XU Wei, XU Jiyuan, LI Maoqin, LU Fei, CHENG Shuli

2023, 26(09):  1104-1111.  DOI: 10.12114/j.issn.1007-9572.2022.0459

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Background

Septic shock may lead to renal perfusion abnormalities, and even acute kidney injury (AKI) , seriously threatening the life of patients. Color Doppler ultrasound (CDU) can be used as a tool to evaluate changes of renal blood flow. However, there are few studies on its evaluation value for AKI in patients with septic shock.

Objective

To examine the value of CDU in assessing AKI and hemodynamic changes in patients with septic shock.

Methods

Participants were recruited from Xuzhou Central Hospital between June 2019 and July 2021, including 105 patients with septic shock, and 58 physical examinees. The general demographics and renal hemodynamic indices measured by CDU 〔the luminal diameter of renal artery (D) , peak systolic velocity (Vs) , end-diastolic velocity (Vd) , resistance index (RI) , pulsatility index (PI) 〕 were collected and compared with the groups. The renal hemodynamic indices were further compared between septic shock patients with and without AKI within 72 h after admission. The predictive value of renal hemodynamic indices for AKI in septic shock was analyzed by receiver operating characteristic (ROC) curve. The influencing factors of AKI in septic shock were explored by univariate and multivariate Logistic regression analyses. Then associations of the severity of AKI (stage 1, 2, 3 AKI) with renal hemodynamic indices were analyzed by Spearman rank analysis.

Results

Thirty-nine septic shock patients had AKI within 72 h after admission, including 19 cases with stage 1 AKI, 15 with stage 2 AKI, and 5 with stage 3 AKI. Septic shock patients had lower D, Vs and Vd, and higher RI and PI than physical examinees (P<0.05) . Septic shock patients with AKI had lower D, Vs and Vd, and higher RI and PI than those without AKI (P<0.05) . AUC of D in predicting AKI in septic shock was 0.782 with 66.67% sensitivity and 80.30% specificity when 4.91 mm was chosen as the optimal cut-off value, that of Vs was 0.772 with 94.87% sensitivity and 51.52% specificity when 71.19 cm/s was chosen as the optimal cut-off value, that of Vd was 0.708 with 58.97% sensitivity and 77.27% specificity when 17.19 cm/s was chosen as the optimal cut-off value, that of RI was 0.842 with 87.18% sensitivity and 66.67% specificity when 0.71 was chosen as the optimal cut-off value, and that of PI was 0.683 with 56.41% sensitivity and 78.79% specificity when 1.50 was chosen as the optimal cut-off value. Multivariate Logistic regression analysis showed that D≥4.91 mm, Vs≥71.19 cm/s and RI≥0.71 were associated with AKI in septic shock (P<0.05) . Patients with stage 3 AKI had lower D, and higher RI than those with stage 2 AKI (P<0.05) . Patients with stage 3 AKI had lower D, Vs and Vd, and higher RI than those with stage 1 AKI (P<0.05) . Patients with stage 2 AKI had lower Vd than those with stage I AKI (P<0.05) . Spearman rank analysis showed that both the D and Vd were strongly negatively correlated with the severity of AKI, and Vs was weakly negatively correlated with it (r_s=-0.421, -0.674, -0.358, P<0.05) . RI was strongly positively correlated with the severity of AKI (r_s=0.539, P<0.001) . PI was not significantly correlated with the severity of AKI (P>0.05) .

Conclusion

CDU could detect the changes of renal hemodynamics in patients with septic shock. Renal hemodynamic indices are related to the development and severity of AKI, which could be used as diagnostic markers or predictors of AKI in septic shock. So it may be possible to diagnose and predict AKI in septic shock by detecting renal hemodynamic indices.

Influence of Microbiota-modulating Agents on Gut Flora in Community Patients with Diabetic Nephropathy

SHEN Fei, JIANG Weiping, MEI Xiaobin, HAN Yiping, ZHAO Jiayi, FAN Jian, GU Juan, SHEN Yanhong, XU Hongmei, ZHANG Dan, MEN Ying, DING Haiguang, CHEN Caiping, HAN Junhua

2023, 26(09):  1112-1117.  DOI: 10.12114/j.issn.1007-9572.2022.0691

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Background

Imbalanced gut flora caused by changes in gut microecological structure and diversity plays an important role in the interaction between diabetes and chronic kidney disease. Rational application of probiotics, prebiotics and other microbiota-modulating agents is contributive to the improvement of gut microbial flora environment and chronic inflammation, as well as the delay of deterioration of renal function in patients with diabetic nephropathy (DN) .

Objective

To understand the effect of probiotics, a microbiota-modulating agent, administered based on gut flora status in patients with DN.

Methods

Participants were selected from Shanghai Yinhang Community Health Center by use of stratified random sampling in 2019, including 115 patients with DN were randomly divided into control group (57 with usual treatment) and treatment group (58 with treatment with microbiota-modulating agents) . Laboratory test indices and intestinal bacterial culture results were compared between the two groups after eight weeks of treatment to assess the effect of microbiota-modulating agents on improving gut flora in DN.

Results

Among 115 patients with DN, there were 28 males and 87 females, the mean age was (62.9±10.0) years, and the duration of diabetic nephropathy was (14.3±7.1) years. There were no significant differences in the proportion of males, mean age, body mass index, proportion of early DN, and duration of DN between DN patients with usual treatment and those with microbiota-modulating agents treatment (P>0.05) . Compared with DN patients with usual treatment, DN patients with microbiota-modulating agents treatment had decreased levels of glucose, triglyceride, blood urea nitrogen, serum creatinine, albumin to creatinine ratio, Cystatin C, C-reactive protein, interleukin-1β, and tumor necrosis factor-α, and increased levels of high-density lipoprotein and estimated glomerular filtration rate after treatment (P<0.05) . Moreover, DN patients with microbiota-modulating agents treatment showed lower numbers of Enterococcus (Z=16.482, P<0.001) and Enterobacter (Z=5.138, P<0.001) colonies, and higher numbers of Bifidobacterium (Z=2.470, P=0.014) , and Lactobacillus (Z=8.384, P<0.001) colonies after treatment.

Conclusion

The number of Enterococcus and Enterobacter colonies decreased and that of Bifidobacterium and Lactobacillus colonies increased in DN patients after treatment with microbiota-modulating agents, indicating that these agents could improve the gut flora.

Serum Metabolomic Study on the Difference between Mild and Severe Acute Pancreatitis Based on Liquid Chromatography-tandem Mass Spectrometry

HUANG Xiangping, WU Ling, TAN Chaochao

2023, 26(09):  1118-1124.  DOI: 10.12114/j.issn.1007-9572.2022.0451

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Background

Mild acute pancreatitis (MAP) has a certain probability of transforming into severe acute pancreatitis (SAP) . Once SAP occurs, it will cause greater harm to patients. It is meaningful for diagnosis and treatment of pancreatitis to explore the transformation mechanism between MAP and SAP.

Objective

This study aimed to explore the differential metabolites, abnormal metabolic pathways and potential biomarkers between MAP and SAP, thus providing reference for early diagnosis and treatment of SAP.

Methods

This study collected 68 AP patients who were hospitalized in Hunan Provincial People's Hospital from August 2020 to March 2021. These 68 patients were divided into MAP group (n=40) and SAP group (n=28) based on the 2012 Revised Atlanta Classification (RAC) criteria. This study used liquid chromatography-tandem mass spectrometry (LC-MS) , and screened out the differential metabolites between the two groups by using univariate analysis (T test, FC) , multivariate analysis (PCA, PLS-DA) , VIP>1, FC >1.5, and P<0.05, thus analyzing the differential metabolites and metabolic pathways between the two groups.

Results

PCA and PLS-DA analyses found that the metabolic profiles of MAP and SAP were significantly different. Combined with VIP>1, FC>1.5, and P<0.05, 50 differential metabolites and 5 metabolic pathways were screened between the two groups, taurine and hypotaurine metabolism, and terpenoid skeleton biosynthesis were the two largest metabolic pathways. Combination with receiver operator characteristic curve (ROC curve) , there were 8 differential metabolites with area under the curve (AUC) >0.9, including 2-phenyl -1, 3-propanediol monocarbamate, diphenhydramine N-glucuronic acid, rac-5, 6-epoxy-retinoyl-β-D-glucuronic acid, hexafluoroisopropanol, NNAL -N-glucuronic acid, erythritol tetranitrate, 3-hydroxybutyric acid, tetrahydrodeoxycorticosterone. Six of them elevated in patients with severe pancreatitis, including 2-phenyl-1, 3-propanediol monocarbamate, rac-5, 6-epoxy-retinoyl-β-D-glucuronic acid, hexafluoroisopropanol, erythritol tetranitrate, 3-hydroxybutyric acid, tetrahydrodeoxycorticosterone. Two of them decreased, including diphenhydramine N-glucuronic acid, NNAL-N-glucuronic acid.

Conclusion

There were significant differences in serum metabolites between MAP and SAP patients, 2-phenyl-1, 3-propanediol monocarbamate, diphenhydramine N-glucuronic acid, rac-5, 6-epoxy-retinoyl-β-D-glucuronic acid, hexafluoroisopropanol, NNAL-N-glucuronic acid, erythritol tetranitrate, 3-hydroxybutyric acid, and tetrahydrodeoxycorticosterone have the larger differential diagnosis efficacy of MAP and SAP. They may be the potential biomarkers between distinguishing MAP and SAP.

Correlation between Preoperative Cervical CT Values of Hounsfield Units and Height Changes of Adjacent Intervertebral Spaces after Anterior Cervical Discectomy and Fusion

KAIYISAIER· Abudukelimu, LI Lei, YANG Xiaokai, REN Jun, LIU Shuai

2023, 26(09):  1125-1130.  DOI: 10.12114/j.issn.1007-9572.2022.0631

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Background

Preoperative vertebral body Hounsfield units (HU) value measured by routine CT examinations may be associated with loss of adjacent segment height after anterior cervical discectomy and fusion (ACDF) . There are few studies on the relationship between preoperative HU value of the vertebral body and postoperative complications of ACDF.

Objective

To study the association between preoperative cervical vertebral body HU value and change of upper adjacent segment height after ACDF.

Methods

A retrospective study of 86 patients diagnosed with cervical spondylotic myelopathy or cervical radiculopathy and treated with single-level ACDF at Department of Spine Surgery, the Sixth Affiliated Hospital of Xinjiang Medical University from January 2017 to January 2021 was conducted. Age, gender, follow-up period, and BMI were all recorded. Preoperative vertebral HU values and Changes in upper adjacent segmental height were measured at 1 week after surgery and the last follow-up time to calculate the values of intervertebral space height loss. Follow-up was till to 2022-02-01. Patients were divided into two groups based on the results of the degeneration of upper adjacent intervertebral space: group A (last follow-up intervertebral space height loss > 20% of the value measured at 1 week postoperatively was defined as upper adjacent intervertebral space degeneration, n=15) and group B (last follow-up intervertebral space height loss < 20% of the value measured at 1 week postoperatively, n=71) . The clinical data between the two groups were then compared. Binary logistic regression analysis was used to investigate the factors influencing the degeneration of upper adjacent intervertebral space. Pearson correlation analysis was used to correlate the preoperative vertebral HU values with the degeneration of upper adjacent intervertebral space. Receiver operating characteristic curve (ROC curve) was plotted for preoperative vertebral CT values to predict postoperative upper adjacent intervertebral space loss in patients.

Results

There were no significant difference in age, gender, the average follow-up time and BMI between two groups (P>0.05) ; There was a significant difference between the two groups in terms of preoperative vertebral HU values (P<0.05) . Binary Logistic regression analysis showed that low preoperative CT value of cervical vertebra 〔OR=1.05, 95%CI (1.02, 1.08) 〕was a risk factor for upper and adjacent intervertebral space degeneration (P<0.05) . There was a negative correlation between the HU values and upper adjacent segmental height loss (r=-0.844, P=0.001) . Using receiver operating characteristic curves, the area under the curve was 0.830〔95%CI (0.732, 0.928) 〕, and the most appropriate threshold of HU value was 329.17 (sensitivity 71.8%, and specificity 86.7%) .

Conclusion

Lower preoperative CT HU values are associated with loss of adjacent segment height after single-level ACDF. Preoperative measurement of cervical body HU is useful in predicting the degeneration of upper adjacent intervertebral space after ACDF.

Cardiac Cutting Edge

Advances in Intensified Antithrombotic Therapies in Acute Coronary Syndrome

DENG Tianhua, HUANG Lin, YOU Zhigang

2023, 26(09):  1131-1135.  DOI: 10.12114/j.issn.1007-9572.2022.0444

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Acute coronary syndrome (ACS) is a serious coronary heart disease with relatively high mortality, and a history of ACS is associated with subsequent risk of recurrent ischemic events such as ischemic stroke and myocardial infarction. Platelet aggregation and thrombus formation are considered as indispensable factors that lead to ACS. To reduce the residual ischemic risk, it is clinically recommended that patients with ACS receive dual antiplatelet therapy with aspirin combined with a potent P2Y12 inhibitor for 12 months, but this therapy has been proven to be unsatisfactory in controlling the risk. More studies are ongoing to explore intensified antithrombotic therapies to reduce the risk of recurrent ischemic events. In this paper, the mechanisms of actions of and advances in intensified antithrombotic therapies in ACS were reviewed, and it is found that the risk of ischemic events can be further reduced by extended-term dual antiplatelet therapy, triple antiplatelet therapy and dual pathway inhibition therapy (namely antiplatelet therapy combined with anticoagulant therapy) . This review will help to the implementation of clinical individualized antithrombotic therapy and the choice of the best antithrombotic strategy.

Hybrid Ablation: a Future Development Trend in the Management of Atrial Fibrillation

ZHANG Ning, HOU Ming, MEI Bo, JIN Weitao, TAN Xiong, YANG Mingchuan, WANG Liang, LIU Yong, LAI Yinglong

2023, 26(09):  1136-1145.  DOI: 10.12114/j.issn.1007-9572.2022.0760

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As the most common type of arrhythmia, atrial fibrillation has proven to be associated with serious adverse cardiovascular and cerebrovascular events, such as heart failure, stroke and myocardial infarction. The global number of patients with atrial fibrillation has exceeded 33 million, and it is estimated to be more than doubled in the next 40 years. Although years of efforts have been made to the research on pathophysiological mechanism, and the exploration of new treatments and improvement of treatments regarding atrial fibrillation, the management of atrial fibrillation is still a difficult problem in clinical medicine, and there is no consensus on the best treatment and the choice of energy source for ablation in atrial fibrillation with the increasing advances made in surgical and catheter ablative techniques. Catheter ablation often requires multiple operations with unsatisfactory success rate and surgical ablation is often associated with high risk of postoperative adverse events. Hybrid ablation, a new treatment recently developed by the joint efforts of cardiac surgeons and electrophysiologists, integrates the merits of catheter ablation and minimally invasive surgical ablation but overcomes the limitations of the two, has proven to be effective in reducing the risk of postoperative adverse outcomes, and considerably efficacious in treating persistent atrial fibrillation, especially long-term persistent atrial fibrillation. We reviewed the advances in atrial fibrillation ablation, and comparatively analyzed existing studies of hybrid ablation, and summarized the advantages and challenges of this treatment, hoping to provide one more option for clinical treatment of atrial fibrillation.

Effect of Epicardial Adipose Tissue on In-stent Restenosis after Percutaneous Coronary Intervention: a Review

AN Jingjing, WANG Xiaojuan, DENG Aiyun

2023, 26(09):  1146-1150.  DOI: 10.12114/j.issn.1007-9572.2022.0453

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As a major treatment for coronary artery disease, percutaneous coronary intervention (PCI) effectively enhances the survival rate of patients. However, the post-PCI in-stent restenosis has become a new cardiovascular problem that is difficult to solve. Inflammation and endothelial dysfunction, as the initiating inducing factors of in-stent restenosis, together with subsequently developed neointimal thickening and neoatherosclerosis based on which, promote the progression of in-stent restenosis. Inflammatory markers secreted by epicardial adipose tissue may directly influence the function of coronary vascular endothelial cells, smooth muscle cells and macrophages, disrupting the homeostasis of the coronary vessel wall, thereby being involved in the pathophysiological process of in-stent restenosis after coronary stenting. In addition, multiple clinical studies have shown that epicardial adipose tissue could partially predict in-stent restenosis in patients with coronary artery disease within 1 year after PCI. We reviewed the latest advances in the effect of epicardial adipose tissue on in-stent restenosis after PCI, and clinical prediction of post-PCI in-stent restenosis by epicardial fat, as well as treatment for post-PCI in-stent restenosis, providing a new idea for the prevention and treatment of post-PCI in-stent restenosis.

Evidence for Optimization

Best Evidence Summary of Exercise Interventions for Osteoporosis in Postmenopausal Women

WANG Xixi, SHEN Rui, WANG Junjie, XU Niying

2023, 26(09):  1151-1158.  DOI: 10.12114/j.issn.1007-9572.2022.0676

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Background

Exercise is one of inexpensive and effective interventions for the prevention and treatment of postmenopausal osteoporosis, but relevant pieces of evidence are wide-ranging and fragmented, and there is no standardized and comprehensive exercise guidance program on clinic.

Objective

To screen and assess the evidence of exercise interventions for postmenopausal osteoporosis, then summarize the best pieces.

Methods

We systematically searched clinical practice guidelines, clinical decisions, evidence summaries, expert consensuses and systematic reviews regarding exercise interventions for postmenopausal osteoporosis in databases of BMJ Best Practice, Up To Date, DynaMed, National Institute for Health and Care Excellence, Guidelines International Network, Scottish Intercollegiate Guidelines Network, National Guideline Clearinghouse, webs of Registered Nurses' Association of Ontario, International Osteoporosis Foundation, Royal Osteoporosis Society, National Osteoporosis Foundation, Royal Australian College of General Practitioners, American College of Obstetricians and Gynecologists, Society of Obstetrics and Gynaecologists of Canada, Medlive, JBI, Cochrane Library, CINAHL, Web of Science, PubMed, Embase, CNKI and SinoMed from inception to January 2022. All relevant evidence was summarized and extracted according to the theme. Appraisal of Guidelines for Research and Evaluation (AGREEⅡ) was used to evaluate the quality of the guidelines, Critical Appraisal for Summaries of Evidence (CASE) was used to evaluate the quality of clinical decisions, the authenticity assessment tool of the expert consensus of the JBI Evidence-Based Health Care Center in Australia (2016 edition) was used to evaluate the quality of expert consensuses, the Australian JBI Evidence-based Health Care Centre System Evaluation Methodology Quality Evaluation Tool (2016 edition) was used to evaluate the quality of the systematic reviews.

Results

A total of 18 studies were included, including seven guidelines, two clinical decisions, four expert consensuses and five systematic reviews. Twenty-two pieces of evidence were extracted, involving five aspects: pre-exercise assessment, exercise type, exercise intensity and time, health education and precautions.

Conclusion

This paper extracts the best evidence of exercise intervention for postmenopausal osteoporosis patients from five aspects: pre-exercise assessment, exercise type, exercise intensity and time, health education and precautions. To reduce the risks of falls and fractures and improve quality of life in postmenopausal women with osteoporosis, it is suggested to provide these women with rational exercise guidance developed based on the best evidence.