Table of Content

15 September 2023, Volume 26 Issue 26

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Guidelines·Consensus

Expert Consensus on the Application of Ulinastatin in Common Clinical Critical Illness

Expert group of expert consensus on the application of ulinastatin in common clinical critical illness

2023, 26(26):  3207-3219.  DOI: 10.12114/j.issn.1007-9572.2023.0157

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Ulinastatin is mainly applied in the treatment of acute pancreatitis, but also in other common clinical critical illnesses such as shock, sepsis, evere pneumonia, cute respiratory distress syndrome, several acute poisoning, severe heat stroke, severe burns, severe trauma, and patients with sudden cardiac arrest for its roles in proteolytic enzymes inhibition and inflammatory responses regulation, which has been recommended by several guidelines/expert consensus on the diagnose and treatment of common clinical critical illness. However, there is currently a lack of consensus on the rational use of ulinastatin in terms of indications, usage, dosage, and others. Therefore, in order to promote the standardized application of ulinastatin, the expert group of expert consensus on the application of ulinastatin in common clinical critical illness summarized the mechanism, pharmacokinetics, indications of ulinastatin and its application methods in the treatment of common clinical critical illness, in order to provide a reference for the rational application of ulinastatin in clinical practice.

Evidence-based Medicine

Selection of Therapeutic Drugs for COVID-19 Infection in Adults with Chronic Kidney Disease Based on Medical Evidence

SU Guobin, LING Xitao, DUAN Ruolan, ZHANG La, XU Yuan, PENG Yu, HOU Haijing, LIU Xusheng, LU Fuhua

2023, 26(26):  3220-3229.  DOI: 10.12114/j.issn.1007-9572.2023.0156

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Chronic kidney disease (CKD) is characterized by abnormal urine test or progressive kidney function decline. Patients with CKD are at a higher risk of COVID-19 infection with higher conversion and mortality rates after infection for their reduced kidney function, long-term use of immunosuppressive agents or combination of underlying diseases. Therefore, rational drug use is particularly important for CKD patients combined with COVID-19 infection. This article summarizes special considerations for the use of relevant medications in patients with CKD by integrating the current evidence of medications for the treatment of COVID-19 infection, including antiviral drugs, anti-inflammatory drugs, antithrombotic drugs, convalescent plasma and neutralizing monoclonal antibodies, as well as commonly used symptomatic drugs of respiratory system (such as antfebrile, antisputum and cough medicine and anti-allergic drugs), high lighting the modified medication regiments according to kidney function levels, in order to provide a reference for clinical professionals, assist in clinical decision-making and rational drug use, and ensure clinical efficacy and safety.

Summary of Best Evidence for Self-Management of Patients with Motor Dysfunction after Stroke

ZHENG Siting, HE Chunyu, ZHOU Jun, KONG Ye, YANG Xinyao, ZHOU Haiying, WEI Xiaofei

2023, 26(26):  3230-3237.  DOI: 10.12114/j.issn.1007-9572.2023.0187

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Background

Self-management meets the long-term rehabilitation needs of stroke patients and their families. However, there is a lack of relevant evidence, and there is no scientific and standardized self-management program in clinical practice.

Objective

To evaluate and summarize the best evidence of self-management in patients with motor dysfunction after stroke.

Methods

PubMed, Cochrane Library, Web of Science, Embase, CINAHL, CNKI, Wanfang Data, VIP, Chinese Biomedical Literature Database (CBM), American Heart Association/American Stroke Association (AHA/ASA), World Stroke Organization (WSO), Chinese Stroke Association (CSA), Guidelines International Network (GIN), Scottish Intercollegiate Guidelines Network (SIGN), National Guideline Clearinghouse (NGC), and Yimaitong were searched for relevant research evidence on self-management of patients with motor dysfunction after stroke from inception to July 2022, including guidelines, expert consensuses, systematic reviews, quasi-experimental studies, and randomized controlled studies. Two researchers independently evaluated the quality of the retrieved literature by using the 2017 version of the Appraisal of Guidelines for Research and Evaluation (AGREE Ⅱ) and the 2016 version of the literature evaluation criteria developed by the Joanna Briggs Institute (JBI) Evidence-based Health Care Center, extracted evidence and graded the quality of the evidence to summarize the best evidence of self-management in patients with motor dysfunction after stroke.

Results

A total of 36 studies were involved, including 9 guidelines, 4 expert consensuses, 5 systematic reviews, 5 quasi-experimental studies, and 13 randomized controlled studies, which were summarized in 6 aspects of organization and management, assessment, exercise instruction, health education, psychological support, monitoring and follow-up, and 34 pieces of best evidence.

Conclusion

The evidence of self-management in patients with motor dysfunction after stroke summarized in this study contains 6 aspects: organization and management, assessment, exercise instruction, health education, psychological support, monitoring and follow-up. Healthcare workers should select the best evidence based on the individual situation and needs of patients in the context of clinical practice, and provide personalized self-management interventions for patients, so as to improve their motor function and self-management ability, promoting the recovery of disease.

Original Research·Monographic Research·Type 2 Diabetic

Risk of Malignant Tumor in Patients with Type 2 Diabetes: a Prospective Population-based Study

CHEN Lunwen, ZHOU Yang, YAN Guodong, SHEN Yi, SUN Chen, CAI Wanli, CHU Minjie, XIAO Jing

2023, 26(26):  3238-3245.  DOI: 10.12114/j.issn.1007-9572.2023.0079

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Background

In recent years, with the aging of the population and the change of lifestyles, patients with type 2 diabetes mellitus (T2DM) have a high prevalence of malignancies, the duration of T2DM and the use of T2DM drugs may accelerate the occurrence of malignant tumor.

Objective

To analyze the risk of incidence and influencing factors of malignant tumors in patients with T2DM.

Methods

Patients with T2DM who were first treated or diagnosed at the Affiliated Hospital of Nantong University from October, 2011 to December, 2020 were prospectively included, with the follow-up termination date of September 30, 2021. The information of tumor incidence and full cause of death of patients were obtained by matching the ID information with the linkage records of the chronic disease tumor registration system and the cause of death registration system of Nantong City. The crudeincidence rate (CIR) and standardized incidence ratio (SIR) of malignant tumors among T2DM patients were calculated separately by gender. Cox proportional hazard regression model was used to explore the effects of the duration of T2DM and drug use on the incidence of malignant tumor in T2DM patients.

Results

A total of 12 006 patients with T2DM were included in this study, involving 6 328 males (52.71%) and 5 678 females (47.29%). After 56 371 person-years of observation (29 543 person-years for males and 26 824 person-years for females), 601 patients with malignant tumor and 11 405 patients with T2DM alone were observed. The CIR of malignant tumor in T2DM patients was 1 093.24/100 000 in men and 1 032.51/100 000 in women, respectively. The top five combined tumors in T2DM patients are colorectal cancer, lung cancer, liver cancer, gastric cancer, and prostate cancer in male, while breast cancer, lung cancer, colorectal cancer, gastric cancer and pancreatic cancer in female. The incidences of colorectal cancer (SIR=2.03), prostate cancer (SIR=2.24), pancreatic cancer (SIR=1.75), kidney cancer (SIR=4.25), thyroid cancer (SIR=3.50) were higher in male T2DM patients than general population, while the incidences of lung cancer (SIR=0.61) and esophageal cancer (SIR=0.22) were lower than general population. The incidences of breast cancer (SIR=2.59), colorectal cancer (SIR=1.57), pancreatic cancer (SIR=2.10), endometrial cancer (SIR=2.83), kidney cancer (SIR=3.67), thyroid cancer (SIR=4.00) were higher in female T2DM patients than general population, while the incidence of esophageal cancer (SIR=0.27) was lower than general population. Compared with T2DM patients with disease duration of 1 to <3 years, the risk of malignant tumor was increased by 91% 〔HR=1.91, 95%CI (1.15, 3.20) 〕, 123%〔HR=2.23, 95%CI (1.37, 3.64) 〕 and 71%〔HR=1.71, 95%CI (1.04, 2.80) 〕in male with disease duration <1 year, 5 to <10 years and≥10 years, respectively, the risk of malignant tumor was increased by 79%〔HR=1.79, 95%CI (1.10, 2.92) 〕 and 99%〔HR=1.99, 95%CI (1.24, 3.19) 〕 in female with T2DM duration of 5 to <10 years and ≥10 years, respectively (P<0.05). Insulin use alone increased the risk of malignant tumor by 72%〔HR=1.72, 95%CI (1.25, 2.36) 〕and 116%〔HR=2.16, 95%CI (1.53, 3.05) 〕 in male and female, respectively (P<0.05). In addition, there was a significant interaction between insulin use and the duration of T2DM in male, the risk of malignant tumor was decreased by an average of 6% with the interaction over the years (P_interaction=0.006) .

Conclusion

In addition to esophageal cancer in both sexes and lung cancer in male, the risk of colorectal cancer, prostate cancer, pancreatic cancer, kidney cancer, thyroid cancer, breast cancer and endometrial cancer increase by 57%-325% in patients with T2DM, and associated with the disease duration and insulin use, with the greatest risk of malignant tumor in male with disease duration of 5 to <10 years and in female with disease duration of ≥10 years. However, there is an antagonistic interaction between insulin use and increased duration of T2DM disease on the incidence of malignant tumor.

Correlation between Glycated Hemoglobin Variability and New-onset Atrial Fibrillation in Type 2 Diabetes Patients Combined with Heart Failure with Preserved Ejection Fraction

FEI Sijie, ZHANG Qiang, LIU Fangfang, BAI Lu, SUN Caihong, XIN Caifeng

2023, 26(26):  3246-3251.  DOI: 10.12114/j.issn.1007-9572.2023.0183

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Background

Diabetes mellitus has been a major concern as a common risk factor for cardiovascular disease. Glycated hemoglobin (HbA_1c) variability is an indicator of long-term blood glucose fluctuation. Therefore, it is of great clinical significance to explore the correlation between HbA_1c variability and new-onset atrial fibrillation (AF) in diabetic patients combined with heart failure with preserved ejection fraction (HFpEF) .

Objective

To investigate the correlation between HbA_1c variability and new onset AF in type 2 diabetes mellitus (T2DM) patients combined with HFpEF.

Methods

The clinical data of 317 T2DM patients combined with HFpEF diagnosed in the Department of Cardiology, the Second Affiliated Hospital of Zhengzhou University from January 2018 to January 2019 were retrospectively analyzed. The follow-up was performed until February 2022, with a mean follow-up time of 3.4 years. The included patients were divided into the AF group (34 cases) and non-AF group (283 cases) based on the presence of new-onset AF during the follow-up period. The HbA_1c variability was expressed as standard deviation of HbA_1c measurement (HbA_1c-SD) and HbA_1c coefficient of variation (HbA_1c-CV). Multivariate Cox regression analysis was used to explore the correlation between HbA_1c variability and new-onset AF in T2DM patients combined with HFpEF. The survival curves were plotted by the Kaplan-Meier (K-M) method. The receiver operating characteristic (ROC) curve of HbA_1c variability predicting new-onset AF in T2DM patients combined with HFpEF was plotted.

Results

The HbA_1c-SD and HbA_1c-CV of patients in the AF group were higher than those in the non-AF group (P<0.05). The included patients were divided into the low HbA_1c variability (HbA_1c-SD≤0.34%, HbA_1c-CV≤4.74%) and high HbA_1c variability (HbA_1c-SD>0.34%, HbA_1c-CV>4.74%) groups according to the median of HbA_1c variability. Log-rank test results showed higher incidence of new-onset AF in patients with high HbA_1c variability (P_HbA1c-SD<0.001, P_HbA1c-CV=0.004). Multivariate Cox regression analysis showed that HbA_1c-SD〔HR=2.22, 95%CI (1.37, 3.61), P=0.001〕 and HbA_1c-CV〔HR=1.65, 95%CI (1.01, 2.67), P=0.001〕 were independent influencing factors for new-onset AF in T2DM patients combined with HFpEF. The AUC of HbA_1c-SD for predicting AF in T2DM patients combined with HFpEF was 0.784 〔95%CI (0.713, 0.855), P=0.001〕, with the optimum cutoff value of 0.36%, sensitivity and specificity of 79.4% and 73.1%, respectively. The AUC of HbA_1c-CV for predicting AF in patients with T2DM and HFpEF was 0.694 〔95%CI (0.591, 0.797), P<0.001〕, with the optimal cutoff value of 4.97%, sensitivity and specificity of 73.5% and 72.1%, respectively.

Conclusion

High HbA_1c variability (HbA_1c-SD>0.34%, HbA_1c-CV>4.74%) is independently associated with an increased risk of new-onset AF in T2DM patients combined with HFpEF, with significant clinical value in predicting AF.

Correlation between Estimated Glucose Disposal Rate and Metabolism-associated Fatty Liver Disease in Type 2 Diabetes

KONG Dexian, XING Yuling, SUN Wenwen, ZHANG Zhimin, ZHOU Fei, MA Huijuan

2023, 26(26):  3252-3258.  DOI: 10.12114/j.issn.1007-9572.2023.0103

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Background

Metabolism-associated fatty liver disease (MAFLD) is considered as a major cause of increased morbidity and mortality from liver disease, type 2 diabetes mellitus (T2DM) is a driving factor in the progression of MAFLD. Estimated glucose processing rate (eGDR) is a simple evaluation indicator of insulin resistance in patients with T2DM, while its relationship with MAFLD has been rarely studied.

Objective

To investigate the correlation between eGDR and MAFLD in type 2 Diabetes and its predictive value.

Methods

A total of 1 434 patients with T2DM who were hospitalized in Hebei Provincial People's Hospital from 2019-01-01 to 2019-12-31 were selected as the study subjects. baseline data of the patients was collected, with their venous blood from the elbow collected for laboratory examination, and liver condition examined by abdominal ultrasound. According to the results of abdominal ultrasonography, T2DM patients were divided into MAFLD group (n=734) and non-MAFLD group (n=700). The subjects were divided into T1 group (eGDR≤5.09, n=477), T2 group (5.09<eGDR≤7.11, n=478) and T3 group (eGDR>7.11, n=479) according to the eGDR tertiles. Spearman rank correlation analysis was used to explore the correlation between eGDR and baseline data. Univariate and multivariate Logistic regression analysis was used to explore the influencing factors of combined MAFLD. The multiplicative interactions of eGDR with gender, age, hypertension, glycated hemoglobin A1c (HbA_1c), BMI and glutamyl transferase (GGT) were evaluated. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of combined prediction model, FBG and HbA_1c for MAFLD in T2DM and areas under curve (AUC) were calculated and compared by Delong test.

Results

Age, disease course, HDL-C and eGDR of MAFLD group were lower than non-MAFLD group. BMI, alcohol consumption, proportions of hypertension and smoking, fasting blood glucose (FBG), uric acid (UA), total cholesterol (TC), TG, low density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), GGT and ALB were higher than non-MAFLD group (P<0.05). The proportion of hypertension, age, BMI, FBG, HbA_1c, Scr and TG in T3 group were lower than those in T1 and T2 groups, GGT was lower than that in T1 group, HDL-C and ALB were higher than those in T1 and T2 groups, the proportion of hypertension, BMI, FBG, HbA_1c and TG in T2 group were lower than those in T1 group (P<0.05). eGDR was negatively correlated with age, FBG and ALB in patients with MAFLD (P<0.05). In patients without MAFLD, eGDR was negatively correlated with age, disease course, FBG, Scr, TG and ALB (P<0.05), and positively correlated with HDL-C, AST and GGT (P<0.05). Multivariate Logistic regression analysis showed that eGDR〔OR=0.814, 95%CI (0.772, 0.858), P<0.001〕, T1 group〔OR=1.310, 95%CI (1.003, 1.712), P=0.048〕and T2 group〔OR=2.554, 95%CI (1.941, 3.359), P<0.001〕 was an influencing factor of T2DM with MAFLD (P<0.05). BMI (P_interaction<0.001), GGT (P_interaction=0.033), hypertension (P_interaction<0.001) had interaction with eGDR. The AUC of the combined prediction model was 0.743, which was greater than FBG (Z=3.227, P=0.001) and HbA_1c (Z=1.877, P=0.061) .

Conclusion

The level of eGDR in T2DM patients with MAFLD is significantly lower than that in patients without MAFLD, and patients with low eGDR level have a higher risk of MAFLD. eGDR is a risk factor for MAFLD with T2MD. The combined prediction model of eGDR can be used as a predictor to evaluate the risk of MAFLD with T2MD.

Development and Validation of a Risk Prediction Model for the Progression from Microalbuminuria to Macroalbuminuria in Patients with Type 2 Diabetes Mellitus

LU Zuowei, CAO Hongwei, LIU Tao, ZHANG Nana, CHEN Yanyan, SHI Qinli, LIU Xiangyang, WANG Qiong, LAI Jingbo, LI Xiaomiao

2023, 26(26):  3259-3268.  DOI: 10.12114/j.issn.1007-9572.2023.0002

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Background

The incidence of diabetic kidney disease (DKD) and the proportion of its related end-stage renal disease in dialysis patients in China are increasing. So it is urgent to take measures to prevent and control DKD. Intensified multifactorial interventions may prevent or delay the progression of DKD. Therefore, developing a personalized risk prediction model can effectively delay or even prevent the progression of DKD and be useful for the prevention and treatment of DKD.

Objective

The purpose of this study was to develop and validate a nomogram for the risk prediction of the progression from microalbuminuria (MAU) to macroalbuminuria (CAU) in type 2 diabetes mellitus (T2DM) patients.

Methods

A total of 1 263 T2DM patients with albuminuria who were hospitalized in Department of Endocrinology, the First Affiliated Hospital of Air Force Medical University from October 2016 to March 2020 were retrospectively recruited and divided into a development cohort of 906 cases and a validation cohort of 357 cases, according to the admission time. LASSO regression was used to screen the optimized variables measured at baseline for CAU. A Nomogram was constructed based on selected predictive factors identified by the multivariate logistic regression model of the development sub-cohort. The receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow (H-L) test were employed to assess the calibration and discrimination of the model. Decision curve analysis (DCA) was performed to evaluate the net clinical benefit of the Nomogram.

Results

The diabetes duration, systolic blood pressure (SBP), glycosylated hemoglobin A1c (HbA_1c), low-density lipoprotein cholesterol (LDL-C), cystatin C (Cys-C), estimated glomerular filtration rate (eGFR), and diabetic retinopathy (DR) were screened as predictive factors for progression from MAU to CAU by LASSO penalty regression. Multivariable Logistic regression analysis using these factors indicated that seven of those potential predictors were present in the final model, diabetes duration≥10 years, SBP≥140 mmHg, HbA_1c≥7.0 mmol/L, LDL-C≥1.8 mmol/L, Cys-C>1.09 mg/L, and DR were risk factors for the progression from MAU to CAU in T2DM patients (P<0.05), while eGFR showed no statistically significant association with the progression in stratified analysis (P>0.05). External and internal validations of the nomogram indicated a good predictive performance. The AUC of the model was 0.814〔95%CI (0.782, 0.846) 〕 in the development cohort, and was 0.768〔95%CI (0.713, 0.823) 〕 in the validation cohort. The model was well fit according to the calibration curve and the H-L goodness of fit test (internal validation: P=0.065; external validation: P=0.451). DCA curve showed that the Nomogram's net benefit was higher than both extreme curves when the threshold probability set between 0.08 and 0.74 in the development cohort, and between 0.14 and 0.70 in the external validation cohort, suggesting potential clinical benefits provided by this Nomogram.

Conclusion

This study finally constructed a prediction model with seven indicators containing diabetes duration, SBP, HbA_1c, LDL-C, Cys-C, eGFR, and DR, and will be a useful clinical predictive tool for the risk of progression from MAU to CAU in T2DM patients.

Original Research·Hot Topics·Children's Health

Healthcare-seeking Behavior and Influencing Factors of Children with Upper Respiratory Tract Infection in the Context of Hierarchical Medical System

ZHANG Lifeng, ZHANG Ningning, QIN Xiuqun, YANG Yi, ZHONG Dongmei, LIU Shaofei, DAI Yushen, WANG Xiaodan, WANG Mingfei

2023, 26(26):  3269-3275.  DOI: 10.12114/j.issn.1007-9572.2023.0061

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Background

Promoting hierarchical treatment is the key to solve the irrational utilization of pediatric medical resources, but there is a lack of relevant studies on the current status of implementation of hierarchical diagnosis and treatment for children.

Objective

To describe the healthcare-seeking behavior of children with upper respiratory tract infection, including number of visits and health-seeking institutions and explore the main influencing factors of first visit of priamry care (community health services) .

Methods

Two questionnaires were administered to the parents of children attending the pediatric outpatient department of the Third Affiliated Hospital of Sun Yat-sen University and the Community Health Service Center in Shipai Street, Tianhe District in the same administrative district from March to July in 2019 and from February to July in 2022 using convenience sampling method, respectively. The included subjects were divided into the 2019 group (n=419) and 2022 group (n=307) according to the survey time. The questionnaire on the healthcare-seeking behavior and its influencing factors of children with upper respiratory tract infection using Anderson model as a theoretical guide was involved, univariate and multivariate Logistic regression analyses were used to explore the influencing factors of the first visit of children with upper respiratory tract infection in primary care.

Results

Among the 419 participated children in 2019, 301 (71.84%) visited for the first time, 87 (20.76%) for the second time and 31 (7.40%) for the third time and fourth time, with 47.49%, 27.12% and 16.13% visited the conmmunity health services centers, respectively. Among the 307 participated children in 2022, 219 (71.34%) visited for the first time, 72 (23.45%) for the second time and 16 (5.21%) for the third time or fourth time, with 41.04%, 39.77% and 43.75% visited the conmmunity health services centers, respectively. The results of multivariate Logistic regression analysis showed that the nearest medical institution was not a community health service center〔OR=0.220, 95%CI (0.147, 1.056), P<0.001〕, the education level of parents was high school or below〔OR=0.584, 95%CI (0.365, 0.936), P=0.025〕, parental assessment of disease severity was less severe and general〔OR (95%CI) =0.399 (0.207, 0.768), 0.388 (0.226, 0.665); P=0.006, 0.001〕, children aged under 3 years old〔OR=0.537, 95%CI (0.309, 0.930), P=0.027〕were correlated with less likely to choose community health service center for their first visit compared with the nearest medical institution was a community health service center, the education level of parents was bachelor's degree and above, parental assessment of disease severity was severe and very severe, children aged 7-13 years old. Parents were more awareness〔OR=2.139, 95%CI (1.284, 3.564), P=0.003〕 and in favor of hierarchical medical system〔OR=2.841, 95%CI (1.937, 5.779), P=0.004〕 were more likely to choose a community health service center for their first visit.

Conclusion

Multiple visits are more common in children with upper respiratory tract infection, the proportion of primary care visits is low. The education level of parents, awareness and and attitudes of hierarchical medical system, assessment of disease severity, the age of children and the nearest medical institution are influencing factors for children with upper respiratory tact infection to choose primary care for their first visit. Strengthening the publicity and education of common disease in children and hierarchical medical system, improving the accessibility of community health service centers and pediatric care conditions would be possible approaches to promote primary care for common children diseases.

Clinical Characteristics of Global Developmental Delay in Children of Different Genders

NIU Guohui, LI Tingting, ZHU Dengna, WANG Jun, LIU Hongxing, WANG Xin, ZHANG Mengmeng, XIE Jiayang

2023, 26(26):  3276-3281.  DOI: 10.12114/j.issn.1007-9572.2022.0844

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Background

Global developmental delay (GDD) is a common neurodevelopmental disorder in childhood whose clinical manifestations are diverse. Currently, there are few large sample analyses of the gender differences of clinical manifestations in GDD children in China.

Objective

To investigate the gender differences of clinical data in GDD children.

Methods

Seven hundred and ninety-nine GDD children who received initial inpatient treatment from Department of Child Rehabilitation, Third Affiliated Hospital of Zhengzhou University from January 2020 to February 2022 were recruited. Clinical data including maternal data in pregnancy and the perinatal period, and general data, measurement results of EEG, brain MRI, the Chinese version of Gesell Developmental Scales-Revised of the children and comorbidity rate were retrospectively collected. Gender differences of clinical data of GDD children were analyzed.

Results

The ratio of male children (n=568) to female children (n=231) was 2.46∶1. The age of first visit in male children〔19.0 (8.8, 33.0) 〕 was older than that of female children〔12.7 (6.8, 27.0) 〕 (P<0.05). The chief complaint was motor retardation (51.1%, 118/231) in female children, and language retardation (41.4%, 235/568) in male children. There were significant differences in chief complaint, birth season, gestational age at birth, gestational age at birth in relation to birth weight, birth weight classification and fine motor classification between male and female children (P<0.05). Male children had lower rates of fetal intrauterine distress, EEG abnormalities and microcephaly and higher rate of autism spectrum disorder than female children (P<0.05) .

Conclusion

There are gender differences in some clinical data of children with GDD. Male children have higher prevalence of GDD, and females have more clinical symptoms.

Characteristics of Unintentional Injuries in 15 773 Children

SHEN Yu, CHEN Jian, SHOU Tiejun, YU Beirong

2023, 26(26):  3282-3289.  DOI: 10.12114/j.issn.1007-9572.2023.0024

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Background

Unintentional injuries are major threats to children's health, but most of them are preventable. Since the incidence and characteristics of distribution of unintentional injuries vary across regions, it is necessary to formulate preventive measures according to local characteristics.

Objective

To investigate the clinical characteristics of unintentional injuries in children in Ningbo, providing a theoretical basis for the development of relevant preventive and treatment measures.

Methods

This study retrospectively recruited 0-17-year-old children with unintentional injuries (including babies, toddlers, preschoolers, gradeschoolers and teens grouped by age) from Department of Emergency, Ningbo Women and Children's Hospital from August 2020 to July 2021. Clinical data were collected, including age, gender, registered residence, the way of getting to the hospital and pre-hospital emergency care, visit time, injury-to-admission time, places of occurrence of injury, cause of injury, site of injury, outcome of treatment, hospitalization time and hospitalization expenses. ICD-10 was used to classify the unintentional injuries, the children were divided into infancy (n=1 225), early childhood (n=5 116), preschool (n=4 447), school age (n=3 219) and adolescence (n=1 766) according to their age, and compared the types of unintentional injuries across the children by clinical data.

Results

Altogether, 15 773 cases〔including 9 608 males (60.91%) 〕were included, with a mean age of (5.3±3.6) years and a male to female ratio of 1.56∶1. Children with fall/fall injuries, burns and scald, cavity foreign body, poisoning, blunt instrument injury and electric shock injuries are mainly early childhood, road traffic injuries are mainly preschool age, and sharp instrument injuries are mainly school age. Most of the children were from rural areas〔59.15% (9 329/15 773) 〕. Children with rural household registration were mainly affected by falls/fall injuries, road traffic accidents, burns, foreign body aspiration, sharp instrument injuries, electric shocks and drowning. Children who suffered from falls, road traffic accidents and drowning mainly arrived at the hospital by self-driving. Children with fall/fall injuries, road traffic injuries, burns, poisoning, sharp device injuries, electric shock injuries and drowning are mainly treated without pre-hospital emergency rescue. Unintentional injuries occurred more frequently in summer〔27.27% (4 301/15 773) 〕. Road traffic injuries and burns are mainly in summer, blunt instrument injuries and electric injuries are mainly in autumn, and bites are mainly in spring and autumn. Unintentional injuries peaked in July and bottomed in February. Visits due to unintentional injuries peaked at 12:00 at noon and 20:00 in the evening. The injury-to-admission time in children with traffic injuries was shorter than that of those with the other injuries (P<0.05). The majority of injuries〔91.27% (14 396/15 773) 〕occurred at home. The top three causes of unintentional injuries were falls〔78.46% (12 375/15 773) 〕, traffics accidents〔5.29% (12 375/15 773) 〕, and burns〔3.70% (583/15 773) 〕. Most unintentional injuries occurred in the head 〔31.79% (5 015/15 773) 〕. Infant, preschool and school-age children mainly have head injuries, and preschool and adolescent children mainly have both upper limbs. Children with drowning had higher hospitalization rate, longer hospitalization time and higher hospitalization expenses than those with other types of unintentional injuries (P<0.05) .

Conclusion

Among Ningbo's children, unintentional injuries, mainly including falls/fall injuries and traffic injuries, highly occur in toddler age, with rural boys as the major suffering group, summer as the high-incidence season, and head as the major site. Different characteristics of children are associated with the type of unintentional injuries. And the type of unintentional injuries is associated with the way of getting to the hospital, injury-to-admission time, the use of pre-hospital emergency care and outcome of hospitalization. Thus, it is important to strengthen the preventive propaganda of unintentional injuries according to children's features to reduce the incidence of such injuries, and to develop rational clinical treatment strategies according to the types of unintentional injuries in children.

Original Research

Relationship between Homocysteine Level and Acute Kidney Injury in Patients with Acute Ischemic Stroke

WANG Xiaowen, XIAO Tongling, WANG Yi, YANG Ying, XIA Xiaoshuang, LI Xin

2023, 26(26):  3290-3296.  DOI: 10.12114/j.issn.1007-9572.2022.0899

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Background

Acute ischemic stroke (AIS) is the second leading cause of death worldwide after coronary heart disease. Acute kidney injury (AKI) is one serious complication after AIS, and homocysteine (Hcy) may be an important factor associated with kidney injury and accelerated deterioration of renal function. However, there are few studies on the relationship between Hcy and AKI, especially in patients with AIS.

Objective

To investigate the relationship between plasma Hcy level and AKI in patients with AIS, and to provide new ideas for the prevention and treatment of AKI.

Methods

Baseline clinical data of 1 202 patients with AIS who were admitted to Department of Neurology, the Second Hospital of Tianjin Medical University were collected from the electronic medical record systemfrom January 2018 to April 2021. Patients were divided into normal Hcy (Hcy≤15 μmol/L, n=618), mild hyperhomocysteinemia (HHcy) (16 μmol/L<Hcy≤30 μmol/L, n=459) and moderate-to-severe HHcy (Hcy>30 μmol/L, n=125) groups according to the Expert Consensus on the Diagnosis, Treatment, and Prevention of Hyperhomocysteinemia. Patients were divided into AKI group and non-AKI group by the values of ambulatorily monitored renal function and urine volume within seven days after admission recommended in the KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Multivariate Logistic regression was used to explore the effects of Hcy on post-AIS AKI as a continuous variable and a categorical variable, respectively. Subgroup analysis was used to investigate the relationship between Hcy and AKI in subgroups. The nonlinear relation between Hcy and AKI was explored by restricted cubic spline regression.

Results

One hundred and fifty patients (12.48%) developed AKI in all subjects. Multivariate Logistic regression showed that after adjustment for potential confounders, the risk of AKI increased by 1.035 times〔OR=1.035, 95%CI (1.019, 1.052), P<0.05〕 for every 1 μmol/L increase in Hcy. With reference to normal Hcy, mild and moderate-to-severe HHcy has been associated with a 1.770-fold〔OR=1.770, 95%CI (1.150, 2.724), P<0.05〕 and 2.927-fold 〔OR=2.927, 95%CI (1.671, 5.126), P<0.05〕 increased risk of AKI, separately. Subgroup analysis found that the risk of AKI after AIS increased with the increase of Hcy level (used as a continuous variable) in females, those aged ≥75 years, those with hypertension, diabetes or moderate to severe stroke at admission, and those whose stroke type was large-artery atherosclerosis (LAA), small artery occlusion (SAO) or cardio embolism (CE) (P<0.05). When Hcy was analyzed as a categorical variable, mild HHcy was associated with a higher risk of AKI compared with normal Hcy in the male population, those aged<75 years, those with hypertension, diabetes, a history of stroke or mild stroke at admission, and those without coronary heart disease (P<0.05). And moderate-to-severe HHcy was associated with a higher risk of AKI compared with normal Hcy in the female population, those with hypertension, diabetes, or moderate or moderate-to-severe stroke at admission, and those whose stroke type was LAA, SAO or CE regardless of age, coronary heart disease and history of stroke (P<0.05). Restricted cubic regression manifested that there was a nonlinear correlation between Hcy and the risk of AKI, and the curve was convex (P=0.026). The risk of AKI after AIS increased rapidly with the increase of Hcy when admission Hcy was less than 17 mmol/L, but increased slowly with the increase of Hcy when admission Hcy was greater than or equal to 17 mmol/L.

Conclusion

Elevated Hcy is a risk factor for AKI whether as a continuous variable or a categorical variable in AIS patients. So monitoring the level of Hcy is conducive to early identification and prevention of AKI, which is helpful to improve the prognosis in AIS patients.

Latent Profile Analysis of Sleep Subtypes in Older Adults with Subjective Cognitive Decline and Its Influencing Factors

TIAN Meng, SONG Yulei, ZHANG Xueqing, MA Yunyun, LIANG Xiao, SHI Jiarui, YIN Haiyan, LUO Dan, XU Guihua, BAI Yamei

2023, 26(26):  3297-3302.  DOI: 10.12114/j.issn.1007-9572.2023.0096

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Background

Sleep disorders combined with subjective cognitive decline (SCD) in older adults are associated with an increased risk of cognitive decline and dementia conversion. However, sleep problems in older adults with SCD have not received sufficient attention, the sleep subtypes of older adults with SCD and their influencing factors need to be further investigated.

Objective

To explore potential sleep subtypes in older adults with SCD and analyze the influencing factors of different sleep subtypes.

Methods

From May to August 2022, older adults with SCD were selected as subjects from the communities in Nanjing, Changzhou, Nantong, and Xuzhou in Jiangsu Province using a stratified convenience sampling method. The general information questionnaire, Subjective Cognitive Decline Questionnaire (SCD-Q9), Beijing Version of the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9 (PHQ-9) and Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index (FRAIL) were used to conduct the survey. The latent profile analysis of sleep in older adults with SCD was performed based on the dimension scores of the PSQI scale, unordered multinomial Logistic regression analysis was used to examine the influencing factors of sleep subtypes in older adults with SCD.

Results

A total of 287 older adults with SCD were enrolled, and the results of the latent profile analysis showed that sleep in older adults with SCD can be classified into 3 potential subtypes: relatively good sleep subtype (n=200), sleep deprivation subtype (n=63), and difficulty falling asleep-medicated hypnosis subtype (n=24), accounting for 69.7%, 21.9%, and 8.4% of all respondents, respectively. There were significant differences in gender, smart phone use, PHQ-9 scores and FRAIL scores among different sleep subtypes (P<0.05). Using the relatively good sleep type as a reference, the unordered multinomial Logistic regression analysis showed that gender 〔sleep deprivation subtype: female, OR=2.479, 95%CI (1.279, 4.808) 〕, smart phone use 〔sleep deprivation subtype: yes, OR=0.269, 95%CI (0.090, 0.808) 〕, PHQ-9 score 〔sleep deprivation subtype: OR=1.755, 95%CI (1.416, 2.175); difficulty falling asleep-medicated hypnosis subtype: OR=1.992, 95%CI (1.540, 2.576) 〕were influencing factors of sleep subtyping (P<0.05) .

Conclusion

Sleep in older adults with SCD showed significant population heterogeneity, and more attention should be paid to the sleep status of older adults with SCD who are female, use smart phones, and have depressive tendencies. Early and precise interventions for different sleep subtypes need to be performed early to improve sleep quality and prevent or delay the development of cognitive impairment.

Correlation of Remnant Cholesterol with Vulnerable Plaque Characteristics in Patients with Acute Coronary Syndrome

YAN Haihao, ZHANG Feifei, DANG Yi

2023, 26(26):  3303-3307.  DOI: 10.12114/j.issn.1007-9572.2023.0093

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Background Remnant cholesterol (RC) is considered an important indicator to assess the risk of atherosclerotic cardiovascular disease (ASCVD), and the adverse effects of vulnerable plaque on the clinical prognosis of ASCVD patients has been demonstrated, however, there are few studies on the correlation between RC and vulnerable plaque characteristics.Objective To investigate the correlation between RC and vulnerable plaque characteristics in patients with acute coronary syndrome (ACS) .Methods One hundred and forth-two ACS patients admitted to Hebei general hospital who underwent percutaneous coronary intervention (PCI) and optical coherence tomography (OCT) from January 2017 to October 2021 were selected as the study subjects. The baseline data of the patients were collected, the characteristics of intracoronary plaques were analyzed by OCT, and the patients were divided into the TCFA group (25 cases) and the non-TCFA group (117 cases) according to the presence or absence of thin-cap fibroatheroma (TCFA) in OCT results. Multivariate Logistic regression was used to analyze the influencing factors of intracoronary TCFA in ACS patients. The receiver operating characteristic (ROC) curve was plotted to assess the predictive value of RC on TCFA; Spearman rank correlation was used to analyze the correlation between RC and intracoronary plaques characteristics.Results The proportion of patients with diabetes history and RC level in the TCFA group were higher than those in the non-TCFA group (P<0.05). The results of multivariate Logistic regression analysis showed that high RC level〔OR=5.241, 95%CI (1.195, 22.995), P=0.028〕was a risk factor for TCFA in ACS patients. The area under the ROC curve (AUC) of RC to predict intracoronary TCFA in patients with ACS was 0.689〔95%CI (0.579, 0.798), P=0.003〕, with an optimal cut-off value of 0.475 mmol/L, sensitivity and specificity of 76.0% and 65.0%, respectively. The results of Spearman rank correlation analysis showed that RC was positively correlated with plaque rupture, TCFA, and macrophage infiltration (r_s=0.213, 0.249, 0.186; P<0.05) .Conclusion Elevated RC level may be a risk factor for TCFA, which has a certain predictive value for plaque vulnerability in ACS patients and is associated with the progression of intracoronary inflammation.

Clinical Study on Low-carbon Diet for Endogenous-insulin-deficient Diabetes Patients

GU Yunjie, SONG Jing, YIN Jun

2023, 26(26):  3308-3313.  DOI: 10.12114/j.issn.1007-9572.2023.0070

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Background

Glycemic control is usually poor in patients with endogenous-insulin-deficient diabetes, while low-carbon diets (LCD) are beneficial for glycemic control among patients with diabetes. However, few studies on LCD in patients with endogenous-insulin-deficient diabetes have been reported.

Objective

To investigate the efficacy and safety of LCD for patients with endogenous-insulin-deficient diabetes.

Methods

A total of 80 patients with endogenous-insulin-deficient diabetes (fasting C-peptide≤0.5 ng/mL) who were hospitalized in Shanghai Eighth People's Hospital from August 2018 to August 2022 were selected as research subjects and divided into the control diet (CD) group with 55 cases and LCD group with 25 cases. The CD group and LCD group were matched by propensity score matching (PSM) in a 1∶1 ratio based on age and diabetes duration as matching indicators and caliper value as 0.3. The two groups of patients were compared in terms of glycemic control on the first day of hospitalization and at discharge, including average blood glucose, coefficient of variation (CV), percentages of time in range (TIR), time below range (TBR) and time above range (TAR); use of antidiabetic drugs, including the numbers and dosages of daily insulin injection and the types of oral antidiabetic agents; incidence of adverse events, including proportion of individuals who developed diabetic ketoacidosis (DKA) or hypoglycemia.

Results

After PSM, 22 patients were included in the CD group and LCD group, respectively. The percentages of CV〔 (26.03±7.61) % vs. (33.79±12.46) % 〕and TAR〔 (20.19±17.57) % vs. (30.43±15.74) %〕were lower in the LCD group than in the CD group (both P<0.05), the percentage of TIR〔 (77.79±17.36) % vs. (67.05±17.59) %〕 was higher in the LCD group than in the CD group (P<0.05). The numbers and dosages of daily insulin injection and the types of oral antidiabetic agents in the LCD group were significantly lower than those in the CD group (P<0.05). There was no significant difference in the incidence of adverse events (4 cases, 18.2% vs.5 cases, 22.7%) between the two groups during hospitalization (P=0.709) .

Conclusion

Compared to general diet, LCD is beneficial in reducing glucose variability, prolonging TIR, reducing the use of antidiabetic agents without increasing the risk of DKA or hypoglycemia for patients with endogenous-insulin-deficient diabetes.

Effects of Intellectual Activities on Different Domains of Cognitive Function in Elderly People

YIN Haiyan, SONG Yulei, XU Guihua, DU Shizheng, LUO Dan, ZHANG Xueqing, BAI Yamei

2023, 26(26):  3314-3319.  DOI: 10.12114/j.issn.1007-9572.2023.0111

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Background

Intellectual activities such as reading and playing puzzle games can slow the decline of cognitive function in the elderly, but the effects of specific types of such activities on cognitive function and cognitive domains need to be further studied.

Objective

To explore the influence of common types of intellectual activities on cognitive function and cognitive domains of the elderly in the community.

Methods

From May to August 2022, stratified convenience sampling was used to select elderly people from four communities in Nanjing, Changzhou, Nantong and Xuzhou of Jiangsu Province. A face-to-face survey was conducted with a general information questionnaire and the Montreal Cognitive Assessment (MoCA) Beijing edition to collect data regarding sociodemographics, frequency and types of intellectual activities, and cognitive function. Stepwise multiple regression analysis was used to explore the relationship between intellectual activities and different cognitive domains.

Results

In total, 782 cases attended the survey, and 758 of them (96.93%) who completed it were included for analysis, including123 from Nanjing, 197 from Changzhou, 240 from Nantong, and 198 from Xuzhou. The intellectual activities done by these older people include learning new knowledge (n=170), playing chess and cards (n=228), reading (n=228), singing (n=59), playing puzzle games (n=57), helping grand children with their homework (n=42), painting (n=16), playing a musical instrument (n=47), and practicing calligraphy (n=30). Stepwise multiple linear regression analysis showed that learning new knowledge, reading, helping grand children with their homework, playing puzzle games and playing musical instruments were associated with cognitive function (P<0.05). Learning new knowledge (B=0.250), reading (B=0.590), playing puzzle games (B=0.585), helping grand children with their homework (B=0.711), and playing musical instruments (B=0.643) were the influencing factors of Visuospatial/Executive (P<0.05). Learning new knowledge (B=0.219) was an influencing factor of Abstraction and Delayed recall/Memory (B=0.727) (P<0.05). Reading was a factor affecting Naming (B=0.095), Attention (B=0.207), Language (B=0.290), Abstraction (B=0.241), and Delayed recall/Memory (B=0.377) (P<0.05). Playing puzzle games (B=0.290) and playing musical instruments (B=0.278) were the influencing factors of Language (P<0.05). Among various types of activities, reading was included in a total of seven regression equations, with a standardized regression coefficient of 0.225 for its impact on the total score of MoCA, which was higher than that of the other types.

Conclusion

Intellectual activities such as reading, learning new knowledge, playing puzzle games, helping grand children with their homework and playing a musical instrument can maintain or improve the cognitive function of the elderly in the community. The effects of different types of intellectual activities on cognitive function are domain-specific, which has a positive significance for the prevention and intervention of cognitive function decline of the elderly.

Prevalence and Epidemiology of Gestational Diabetes Mellitus from 2014 to 2021 in Hebei Province

TIAN Meiling, MA Guojuan, DU Liyan, XIAO Yuange, ZHANG Sai, ZHANG Cui, TANG Zengjun

2023, 26(26):  3320-3324.  DOI: 10.12114/j.issn.1007-9572.2023.0125

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Background

Gestational diabetes mellitus (GDM) is one of the common pregnancy complications, which not only increases the maternal risk of short-term and long-term complications such as maternal preeclampsia and type 2 diabetes, but also the incidence rates of fetal malformation, macrosomia, etc. GDM has become a public health and social issue which can not be ignored.

Objective

To investigate the prevalence and epidemiological characteristics of GDM in Hebei Province.

Methods

Using a cross-sectional study method, the relevant data of inpatient deliveries from maternal monitoring information system involving 22 monitoring hospitals provided by Hebei Center for Maternal and Child Health were collected, including maternal delivery hospital, maternal age, marital status, education level, number of pregnancies, deliveries and prenatal examinations, season of delivery, complications during this pregnancy, mode of delivery, gender and body mass of newborn, and occupancy at NICU.

Results

A total of 366 212 pregnant women were enrolled in this study, 25 995 of whom were diagnosed with GDM, with the incidence rate of 7.1%. The prevalence of maternal GDM showed an upward trend year after year from 2014 to 2021 (χ²_trend=6 921.4, P<0.001). The incidence rate of GDM in advanced maternal aged (χ²_trend=779.0, P<0.001) and urban maternity (χ²_trend=5 057.1, P<0.001), showing an upward trend year after year. And there were statistical significant differences in the prevalence of GDM among different regions of Hebei Province (χ²=16 919.785, P<0.001). The prevalence of maternal GDM in urban〔10.6% (19 200/180 369) 〕was higher than rural〔3.7% (6 795/185 843) 〕 from 2014 to 2021 in Hebei Province (χ²=6 872.800, P<0.001). There were significant differences in prevalence of maternal GDM among primary〔0.7% (34/4 731) 〕, secondary〔3.7% (6 733/180 923) 〕, and tertiary hospitals〔10.6% (19 228/180 558) 〕from 2014 to 2021 in Hebei Province (χ²=6 872.800, P<0.001). There were statistically significant differences in the prevalence of maternal GDM among women of different maternal age, educational level, number of pregnancies, deliveries and prenatal examinations (P<0.05); The prevalence of GDM in women aged 18-<35, 35-<40, and ≥40 years was higher than women aged <18 years, and the prevalence of GDM in women aged 35-<40, and ≥40 years was higher than women aged 18-<35 years; The prevalence of GDM of women with university or higher education level was higher than women with high school, junior high school, primary school and illiteracy; The prevalence of GDM of women with multiple pregnancies was higher than women with 1 pregnancy; The prevalence of GDM of multipara was higher than unipara; The prevalence of GDM of women ≥8 prenatal examinations was higher than women of <8 prenatal examinations. There were statistically significant differences in the prevalence of maternal GDM among women with deliver season of spring (March to May) 〔7.27% (6 583/90 546) 〕, summer (June to August) 〔6.95% (6 360/91 521) 〕, autumn (September to November) 〔7.08% (6 632/93 729) 〕 and winter (December to February) 〔7.10% (6 420/90 416) 〕 from 2014 to 2021 in Hebei Province (χ²=9.350, P<0.05). The differences in maternal GDM were statistically significant when comparing the combination of gestational hypertension, anemia and uterine atony, delivery modes, and deliver of macrosomia (P<0.05) .

Conclusion

The prevalence of GDM in Hebei Province was 7.1% from 2014 to 2021, showing an upward trend from 2014-2021. And the prevalence of GDM is increased in women with advanced age, living in urban, with high education level, multiple pregnancies, and multipara.

Related Factors of Pathological Upgrading in Gastric Mucosal Lesions after Endoscopic Submucosal Dissection

GAO Rongjian, WU Haili, BI Jianhong, KANG Kai, GUO Xing, LIU Juan, LI Xiaoli, MENG Cunying

2023, 26(26):  3325-3329.  DOI: 10.12114/j.issn.1007-9572.2023.0012

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Background

Early diagnosis of gastric cancer is essential for patient prognosis. Currently, endoscopic forceps biopsy (EFB) is an important tool for the diagnosis of gastric cancer. However, it has been shown in relevant studies that there are some differences between EFB-based diagnosis and pathological diagnosis after endoscopic submucosal dissection (ESD), resulting in an underestimation of the patient's condition. No related research has been conducted in northern Shaanxi.

Objective

To calculate the rate of pathological upgrading in gastric mucosal lesions after ESD in five hospitals in northern Shaanxi, and to analyze the factors associated with pathological upgrading.

Methods

We recruited patients with gastric mucosal lesions who underwent ESD following EFB in five hospitals (Yan'an University Affiliated Hospital, Yan'an People's Hospital, the First Hospital of Yulin, Yan'an Traditional Chinese Medicine Hospital, Zichang People's Hospital) from 2016 to 2021. We classified the pathological results of gastric mucosal lesions into the following categories: chronic gastric inflammatory changes (CIC), low-grade gastric intraepithelial neoplasia (LGIN), high-grade gastric intraepithelial neoplasia (HGIN), early gastric cancer (EGC) and progressive gastric cancer. The difference between EFB-based diagnosis and pathological diagnosis of ESD specimens was analyzed. Pathological upgrading was defined as progression in pathological results. The pathological upgrading in patients with CIC, LGIN or HGIN was counted. The factors associated with pathological upgrading were analyzed.

Results

A total of 241 patients were included. The EFB-based diagnosis of CIC, LGIN, HGIN, and EGC were 84, 75, 65, 17 cases, respectively. Seventy-six (31.5%) were found with pathological upgrading after ESD compared with their EFB-based diagnoses. Binary logistic regression analysis showed that endoscopic classification〔OR=0.134, 95%CI (0.029, 0.617) 〕 and superficial ulceration〔OR=3.595, 95%CI (1.226, 10.536) 〕 were associated with pathological upgrading in CIC by EFB-based diagnosis (P<0.05). Age〔OR=3.961, 95%CI (1.071, 14.650) 〕, endoscopic classification〔OR=0.311, 95%CI (0.127, 0.765) 〕, redness of mucosal surface〔OR=5.830, 95%CI (1.591, 21.355) 〕, and number of specimens〔OR=0.234, 95%CI (0.063, 0.872) 〕 were associated with pathological upgrading in LGIN by EFB-based diagnosis (P<0.05). Lesion size〔OR=3.143, 95%CI (1.003, 9.852) 〕 was associated with pathological upgrading in HGIN by EFB-based diagnosis (P<0.05) .

Conclusion

Medical workers should be alert to the potential possibility of underestimated pathology in EFB if the lesion is CIC suggested by EFB but is endoscopically classified as flat or concave with surface ulceration. And the potential possibility is also should be considered if there is only one biopsy specimen obtained from a patient aged greater than 60 years, and the lesion is LGIN suggested by EFB, but is endoscopically classified as flat with redness of mucosal surface, and an ESD can be underwent if necessary. Moreover, if a lesion greater than 2 cm in size is HGIN suggested by EFB, which is probably EGC, and an ESD is recommended to verify it.

Review & Perspectives

Research Progress of Ocular Glymphatic System and Related Ocular Diseases

ZHU Guangyu, CHENG Yuxin, LU Xuejing

2023, 26(26):  3330-3334.  DOI: 10.12114/j.issn.1007-9572.2022.0901

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Recent discovered ocular glymphatic system, which is facilitated by aquaporin-4 (AQP4) and dependent on the exchange system of aqueous humor-tissue fluid in the perivascular space of retinal arterial and venous, ultimately acts as the role of expelling neurotoxic substances such as beta-amyloid out of the eye, has updated our knowledge of intraocular circulation. This paper reviews the composition and function of ocular glymphatic system, describes its specific circulatory paths in the physiological state and mechanism of impairment in the progression of glaucoma, optic disc edema, Terson syndrome and other diseases, In the future, we can identify the specific regulatory links of the ocular glymphatic system and improve the function of the system, such as using the advantages of multiple targets and multiple pathways of traditional Chinese medicine to promote the removal of metabolic wastes in the eye, which will bring hope to the treatment of many eye diseases such as glaucoma and some central nervous system diseases.