Table of Content

20 September 2023, Volume 26 Issue 27

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Review & Perspectives

Transcranial Low-level Laser Therapy: a Novel Treatment for Depression

LIANG Xuemei, WANG Rui, ZHAO Yuhuan, XU Tianjiao, WANG Wei, SUN Weidong

2023, 26(27):  3335-3341.  DOI: 10.12114/j.issn.1007-9572.2022.0688

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As the second most serious disease worldwide, the etiology and pathogenesis of depression have not been clearly defined. Depression treatment faces a bottleneck, due to limitations of common therapies, such as side effects associated with drug therapy and high risk of recurrence after drug therapy, high requirements for clinicians to perform psychotherapy, and high cost of modalities and disorientation in physical therapy. Transcranial low-level laser, a new therapy has recently proven to be effective in scientific research and clinical antidepressant treatment, utilizes low-level laser non-invasively passing through the skull without causing damage to regulate biological tissues and protect neurons. Even though the molecular and cellular mechanisms underlying the therapy for depression are not yet clear, this non-drug therapy could be highly promising for depression treatment.

Review & Perspectives

Advances in Rehabilitation Outcomes and Care in Patients with Prolonged Disorders of Consciousness

TANG Shilan, XIE Kexin, LIU Lingyu, QI Tiantian, YANG Yansui

2023, 26(27):  3342-3348.  DOI: 10.12114/j.issn.1007-9572.2023.0088

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Prolonged disorders of consciousness (pDoC) severely affects the patients' survival and quality of life, and causes an extremely heavy disease burden. At present, considerable resources and studies have focused on the acute care of patients with pDoC, and substantial progress has been made in detecting, predicting and promoting recovery of consciousness, but there is little research on post-acute rehabilitation outcomes and care. In views of this, we reviewed the definition, epidemiological surveys, clinical symptoms and diagnosis criteria of pDoC, summarized the associated factors, interventions and nursing regarding rehabilitation outcomes of pDoC. Then, we put forward the following recommendations relevant to future research and practice in China: (1) improving the epidemiological data related to pDoC to provide data for relevant decision-making; (2) studying and applying new technologies to interventions for pDoC rehabilitation, and integrating clinical practice, rehabilitation prediction and prognostic management; (3) further identifying key elements and trajectory for pDoC recovery to reduce the uncertainty of prognostic outcomes due to excessive disease duration; (4) establish a continuity of care system based on the pDoC rehabilitation trajectory from acute transition, sub-acute to chronic period to improve the quality of and access to care and achieve continuous improvement in the quality of care; (5) systematically reforming the current care system to further improve the continuity of care system that contributes to rehabilitation, and strengthening the participation of the patient's family, community, disability agencies and other stakeholders besides the multidisciplinary team and the cooperation between them. It is hoped that we can provide insights into the development of research and clinical practice of pDoC in China.

Review & Perspectives

Recent Strides in Novel Treatments for Inflammatory Bowel Disease

CHEN Xiaofen, CHEN Yuhan, MA Juan

2023, 26(27):  3349-3354.  DOI: 10.12114/j.issn.1007-9572.2022.0720

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Inflammatory bowel disease (IBD) is a chronic non-specific intestinal inflammatory disease featured by repetitive episodes of gastrointestinal inflammation, including ulcerative colitis and Crohn's disease. The etiology and pathogenesis of IBD have not been fully identified, and there is still no cure currently. Nevertheless, new treatments have been developed recently, such as biological agents and small-molecule drugs, stem cell transplantation, fecal bacteria transplantation, and monocyte adsorption apheresis, along with the roles of TNF-α, interleukin, integrin receptors, JAK/STAT pathway and intestinal flora in the pathophysiology of IBD gradually revealed by increasingly deepening research on IBD. Although many new treatments are still being researched, they have been proven effective and safe, which might make up for the shortcomings of previous therapies, and may be alternative choices for individualized treatment of IBD in the future. This article reviews the recent developments in novel treatments for IBD.

Monographic Research

Percutaneous Coronary Intervention via Distal Transradial Approach: Strengths, Weaknesses, Opportunities and Challenges

LAN Yonghao, KE Erqin, HAN Rui, MEI Yingchen, LIU Wei

2023, 26(27):  3355-3360.  DOI: 10.12114/j.issn.1007-9572.2022.0874

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As a new approach for percutaneous coronary intervention, distal transradial approach (dTRA) is increasingly applied in clinical practice. Thus dTRA is superior to transradial artery approach in improving patient and surgeon comfort, reducing the incidence of complications and forearm arterial injuries, while it also has many limitations, such as lower success rate, longer learning cycle, higher level of puncture site pain, and relatively higher incidence of radial artery spasm. And dTRA has also been used as an approach for acute coronary syndrome and complex percutaneous coronary intervention. But it still needs further verification whether dTRA is suitable for mass promotion and application. This paper reviews and analyzes the strengths, weaknesses, opportunities and challenges of dTRA, in order to provide a theoretical basis for scientific and rational application of dTRA in percutaneous coronary intervention.

How to Improve the Success Puncture Rate of Distal Transradial Artery Approach, "Winding Path to the Secluded": Summary of the Experience of More than 2 000 Cases

CAI Gaojun, SHI Ganwei, LI Feng, LI Wenhua, YAN Yongmin, XUE Sheliang, XIAO Jianqiang, GU Jun, SONG Yanbin, ZHANG Liuyan, LU Wei, GONG Chun

2023, 26(27):  3361-3365.  DOI: 10.12114/j.issn.1007-9572.2022.0867

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Percutaneous coronary diagnosis and intervention via distal transradial artery approach has become one of the hot research topics in the field of coronary angiography and intervention. Compared with transradial approach, the distal transradial artery approach has the advantages of higher patient comfort and fewer related complications; however, due to the tortuosity of radial artery and relatively small size of distal radial artery, there is a significant learning curve for distal transradial artery approach puncture. This paper analyzes and summarizes the common causes (mainly including patient factors and operational factors) and treatment strategies of distal transradial artery approach puncture failure based on the experience of more than 2 000 cases, in order to provide a reference for improving the success rate of puncture and promoting the application of distal transradial artery approach.

Feasibility, Safety and Timing of Secondary Percutaneous Coronary Intervention via Distal Transradial Artery Approach

LIU Minghao, WANG Pan, GAO Lijian, XU Shuqing, WANG Huanhuan, ZHAO Guangxian, CHEN Jue, QIAO Shubin, XU Bo, YUAN Jinqing

2023, 26(27):  3366-3372.  DOI: 10.12114/j.issn.1007-9572.2022.0868

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Background

Percutaneous coronary intervention (PCI) via distal transradial artery approach (dTRA) is effective in reducing the incidence of radial artery occlusion, however, there are no reports on the feasibility, safety and timing of secondary PCI via dTRA domestically.

Objective

To explore the feasibility, safety and timing of secondary PCI via dTRA.

Methods

A total of 70 patients who were to undergo secondary PCI via dTRA in Fuwai Hospital, CAMS&PUMC from July 2021 to July 2022 were consecutively included and divided into ≤30 d group (n=33) and >30 d group (n=37) according to the time interval since the last PCI via dTRA. The general clinical data, operation-related indicators, coronary artery lesions and radial artery inner diameters at 5, 10 and 15 cm proximal to the radial styloid process before and 24 h after PCI were compared between the two groups.

Results

The dTRA puncture and catheterization were successfully conducted in 69 of 70 patients, with a success rate of 98.6% (69/70) . Second PCI via dTRA was successfully completed in 66 of 67 patients assessed for secondary PCI, with a success rate of 98.5% (66/67) . There were significantly difference in age, platelet count, incidence of diabetes, number of lesioned vessels and ACC/AHA coronary artery lesions typing (P<0.05) . The compression bandage was released 3 hafter surgery, and the radial artery pulsation on the puncture side was palpable immediately and 24 h after surgery, and none of the patients occurred radial artery occlusion, with the radial artery patency rate of 100.0% (69/69) . The radial artery inner diameters at 5, 10 and 15 cm proximal to the radial styloid process in ≤30 d group were significantly greater than that in >30 d group before and 24 h after PCI when comparing between the two groups, respectively (P<0.05) . Radial artery inner diameter at 15 cm proximal to the radial styloid process 24 h after PCI was smaller than that before surgery in ≤30 d group, radial artery inner diameter at 5 cm proximal to the radial styloid process 24 h after PCI was smaller than that before surgery in >30 d group (P<0.05) .

Conclusion

Secondary PCI via dTRA is safe and feasible independent of first dTRA PCI time (≤30 days or >30 days from the first dTRA PCI) , and the timing of secondary PCI via dTRA should be determined according to the patient's condition and puncture site.

Feasibility of Retrograde Recanalization of Occluded Radial Artery via Distal Transradial Artery Approach: a Single-center Prospective Study

YUAN Mingpei, LIN Yaowang, BEI Weijie, LIU Huadong, DONG Shaohong, SUN Xin

2023, 26(27):  3373-3377.  DOI: 10.12114/j.issn.1007-9572.2022.0869

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Background

The incidence of radial artery occlusion (RAO) after coronary intervention via transradial artery approach (TRA) is high. But there is a lack of long-term follow-up studies with a large sample size on retrograde recanalization of occluded radial artery via distal transradial artery approach (dTRA) .

Objective

To assess the feasibility of dTRA for retrograde recanalization of occluded radial artery.

Methods

Forty-four patients undergoing retrograde recanalization via dTRA for treating RAO after coronary intervention via TRA were consecutively recruited from Shenzhen People's Hospital from June 2019 to December 2021. The primary observation index was postprocedural radial artery patency. And secondary observation index included possible predictors of failed retrograde recanalization, incidence of adverse events during hospitalization, and patency rates of radial artery at 3, 6 and 12 months after procedure.

Results

The success rate of postprocedural radial artery patency was 88.6% (39/44) , and divided into groups of successful (n=39) and failed (n=5) according to the result of the procedure. Compared with the successful group, the failed group had higher percentages of diabetics, current smokers and chronic total occlusion of the coronary artery, as well as a significantly lower prevalence of undergoing balloon angioplasty (P<0.05) . There was significant intergroup difference in the times of coronary interventions (P<0.05) ; there was no significant intergroup difference in the incidence of bleeding or hematoma at the access site during hospitalization (P>0.05) . The patency rates of radial artery in successful group were 48.7% (19/39) , 43.6% (17/39) , and 35.9% (14/39) at 3, 6, and 12 months after procedure, respectively.

Conclusion

The dTRA may be feasible for retrograde recanalization of occluded radial artery, which showed a high procedural success rate up to 88.6%, but the long-term patency rate was less than 50.0%. Diabetes, smoking, times of coronary interventions, chronic total occlusion of coronary artery, and receiving no balloon angioplasty may be influencing factors of failed retrograde recanalization of occluded radial artery via dTRA. And dTRA for retrograde recanalization of occluded radial artery is recommended for patients with RAO who also require elective coronary intervention.

Effectiveness, Safety and Satisfaction of Distal Transradial Artery Approach in Cerebral Angiography

LU Bin, XIANG Chong, YUAN Xuesong, CAI Gaojun, WEI Wenfeng, YAN Yongmin

2023, 26(27):  3378-3382.  DOI: 10.12114/j.issn.1007-9572.2022.0882

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Background

Cerebral angiography is an important means for the assessment of cerebrovascular diseases. In recent years, distal transradial artery approach (dTRA) has gradually been used in cerebral angiography, but there are few reports on its effectiveness and safety.

Objective

To compare the effectiveness, patient safety and satisfaction between transradial artery approach (TRA) and dTRA in cerebral angiography.

Methods

Totally 135 patients who were hospitalized in Department of Neurosurgery, Wujin Hospital Affiliated to Jiangsu University from January 2020 to June 2022 for cerebral angiography were selected. They were divided into TRA group (n=72) and dTRA group (n=63) by the approach used in cerebral angiography, and the puncture time, duration of cerebral angiography, puncture success rate, X-ray exposure time, incidence of puncture site complications and serious cardiovascular and cerebrovascular events within three days after cerebral angiography, and levels of pain and satisfaction within 24 hours after cerebral angiography were compared between the groups.

Results

The mean puncture time in dTRA group was much longer than that of TRA group (P<0.05) . The mean duration of cerebral angiography was also significantly longer in dTRA group (P<0.05) . The puncture success rate in dTRA group was much lower (P<0.05) . There was no statistically significant difference between the groups in terms of average X-ray exposure time or the incidence of puncture site complications within three days after cerebral angiography (P>0.05) . No serious cardiovascular and cerebrovascular events occurred in both groups within three days after cerebral angiography. dTRA group had much lighter pain level and significantly higher satisfaction within 24 hours after cerebral angiography than TRA group (P<0.05) .

Conclusion

Compared with TRA, dTRA is also safe and effective for cerebral angiography, and helps to reduce patients' pain level and improve their satisfaction, so dTRA can be used as one alternative approach for cerebral angiography, but it requires higher level of puncture skills and takes a longer time, so operators need to spend a certain amount of time on relevant learning and training.

Article

Lipid Goal Attainment Rate and Influencing Factors in 45-year-old or Younger Acute Coronary Syndrome Patients with an Ultra-high Risk of Atherosclerotic Cardiovascular Disease after Lipid-lowering Treatment

GAO Yang, WANG Yunxia, ZHANG You, GAO Chuanyu

2023, 26(27):  3383-3387.  DOI: 10.12114/j.issn.1007-9572.2023.0034

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Background Acute coronary syndrome (ACS) is a group of critical conditions commonly encountered clinically, showing a trend of younger age of onset in recent years. Effective lipid-lowering therapy can improve the prognosis of patients. Various guidelines are increasingly strict on lipid-lowering targets, and the lipid-lowering efficacy in young ACS patients with an ultra-high risk atherosclerotic cardiovascular disease (ASCVD) needs further evaluation.Objective To evaluate the rate of lipid goal attainment and influencing factors in young acute coronary syndrome ACS patients (≤45 years old) with an ultra-high risk of ASCVD after lipid-lowering treatment.Methods Patients with ACS aged 18-45 years who were hospitalized in Fuwai Central China Cardiovascular Hospital from January 2019 to October 2021 were enrolled. Patient baseline data were collected through the electronic medical record system. Venous samples were collected after eight hours of fasting, and serum lipid〔including total cholesterol (TC) , triacylglycerol (TG) , low-density lipoprotein cholesterol (LDL-C) , high-density lipoprotein cholesterol (HDL-C) 〕in which were analyzed using a fully automated biochemistry analyzer, and non-HDL-C was calculated. All patients underwent blood lipid detection again in the outpatient or inpatient department of our hospital 1 month after discharge. In this study, the first blood lipid record was adopted 1 month after discharge, and the last follow-up date was November 30, 2021. Among the patients, 445 cases were found with an ultra-high risk ASCVD, and 84 of them were detected with attained lipid goals (attainment group) , and the other 361 with poor attainment of lipid goals (non-attainment group) . Spearman rank correlation analysis was used to measure the correlation of lipid goal attainment with various other parameters. Univariate and multivariate Logistic regression were used to analyze the influencing factors of lipid goal attainment in ASCVD patients.Results Patients with an ultra-high risk of ASVCD accounted for 87.4% (445/509) of ACS patients, and 18.9% (84/445) of them had achieve the LDL-C target after lipid-lowering treatment. A total of 29 patients received statins combined with evolocumab, of whom 24 reached the lipid goals. Attainment and non-attainment groups had statistically significant differences in the ratio of having a diabetes history, prevalence of previous acute myocardial infarction (AMI) , results of adenosine triphosphate-binding cassette subfamily B member 1 (ABCB1) and solute carrier organic anion transporter family member 1B1 (SLCO1B1) , levels of TC and TG, and baseline levels of LDL-C and non-HDL-C, as well as lipid-lowering therapies (P<0.05) . In comparison with non-attainment group, attainment group had lower prevalence of using the moderate-intensity statin therapy, and higher prevalence of using the therapy with statin and evolocumab (P<0.05) . Spearman rank correlation analysis showed that diabetes history, previous AMI, ABCB1-positive, SLCO1B1-positive, TC, TG, baseline LDL-C and non-HDL-C were weakly positively correlated with lipid goal attainment (P<0.05) , and the therapy with statin combined with evolocumab was moderately positively correlated with lipid goal attainment (P<0.05) . There was a moderate negative correlation between moderate-intensity statin therapy and lipid goal attainment (P<0.05) . Multivariate Logistic regression analysis showed that diabetes history〔OR=1.806, 95%CI (1.049, 3.110) 〕, previous AMI〔OR=2.245, 95%CI (1.288, 3.913) 〕, and the therapy with statins combined with evolocumab〔OR=31.635, 95%CI (11.386, 87.896) 〕were associated with lipid goal attainment in ASCVD patients (P<0.05) .Conclusion The majority of young ACS patients had an ultra-high risk of ASCVD, but only less than one fifth of them attained the lipid goal. Those with a history of diabetes, AMI, or using the therapy with statins and evolocumab were more likely to achieve the LDL-C target.

Risk Stratification of Atherosclerotic Cardiovascular Disease and Lipid Goal Attainment in Hypertensive Patients Registered in Community

BIAN Lili, LI Xiaoxiao, DU Xueping, DAI Qinfang, WU Lin, SONG Beibei

2023, 26(27):  3388-3391.  DOI: 10.12114/j.issn.1007-9572.2023.0123

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Background Hypertension and dyslipidemia are major risk factors of cardiovascular and cerebrovascular diseases in Chinese residents. Mastering the risk stratification of atherosclerotic cardiovascular disease (ASCVD) in community residents with hypertension and formulating individualized lipid intervention targets will significantly contribute to the improvement of management of hypertension in primary care and the enhancement of lipid goal attainment rate in residents.Objective To investigate the risk stratification of ASCVD and lipid goal attainment status in hypertensive patients in Beijing's community, providing data support for comprehensive management of hypertension in the community.Methods A total of 2 943 hypertensive patients registered in Yuetan Community Health Center and Qinan Community Health Station from 2019 to 2021 were included. Non-high-density lipoprotein cholesterol (non-HDL-C) was calculated and estimated glomerular filtration rate (eGFR) was calculated from baseline data collected by reviewing health records and electronic medical records. The risk of ASCVD was stratified and blood lipid goal attainment was observed in the patients.Results The participants consisted of 1 201 males and 1 742 females, with a median age of 70 (63, 80) years. High, moderate and low risks of ASCVD were identified in 2 165, 485 and 293 cases, respectively. The LDL-C goal attainment rate was 10.5% (227/2 165) in high-risk patients, 22.9% (111/485) in moderate-risk patients, and 98.0% (287/293) in low-risk patients. Patients with concomitant coronary heart disease had statistically significant higher lipid goal attainment rate than those without 〔14.1% (116/823) vs 9.1% (192/2 120) 〕 (χ²=16.060, P<0.001) . The rate of lipid goal attainment in patients with concomitant stroke was statistically significant higher than that in those without 〔15.5% (41/264) vs 10.0% (267/2 679) 〕 (χ²=7.940, P=0.005) .

Conclusion

Hypertensive patients with moderate or high risk of ASCVD had low lipid goal attainment rate. And those with high risk of ASCVD and concomitant other high risk factors had unsatisfactory lipid control status. Attention should be paid to the management of blood lipid in hypertension patients to improve their blood lipid control rate and reduce their risk of ASCVD.

Correlation between the Severity of Metabolic-associated Fatty Liver Disease and Thyroid Nodules

BAI Yitong, LIN Lianjie, PEI Dongmei

2023, 26(27):  3392-3396.  DOI: 10.12114/j.issn.1007-9572.2023.0067

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Background

Both fatty liver disease and thyroid nodules are common clinical chronic diseases that are closely related to metabolism, but there is little research on whether there is a certain correlation between them.

Objective

To explore the overall and disease severity-specific correlations between metabolic-associated fatty liver disease (MAFLD) and thyroid nodules.

Methods

This study selected 666 MAFLD patients〔including 316 mild cases (group A) , and 350 moderate to severe cases (group B) 〕, and 330 health examinees (group C) from Shengjing Hospital of China Medical University from December 2020 to December 2021. All the subjects underwent general anthropometric measurement, blood tests and ultrasound examination of the liver and thyroid. Multivariate Logistic regression was used to explore the influencing factors of thyroid nodules in MAFLD.

Results

The prevalence rate of thyroid nodules in group C (19.70%, 65/330) was lower than that in group A (25.36%, 81/316) or B (34.86%, 122/350) (P<0.05) . Compared with group A, group B had higher prevalence rate of thyroid nodules (P<0.05) , and higher prevalence rates of C-TIRADS 3 and ≥4 thyroid nodules (P<0.05) . Multivariate Logistic regression analysis showed that age (OR=1.447) , BMI (OR=2.847) , triacylglycerol (TG) (OR=2.947) , total cholesterol (TC) (OR=3.235) , fasting plasma glucose (FPG) (OR=2.780) and glycated haemoglobin (HbA_1c) (OR=3.371) were the risk factors of thyroid nodules in MAFLD (P<0.05) .

Conclusion

MAFLD is associated with increased prevalence rate of thyroid nodules. The risk of malignant thyroid nodules increases with the aggravation of hepatic steatosis (namely progression from mild/moderate to severe) . Age, BMI, TG, TC, FPG and HbA_1c are associated factors of MAFLD complicated with thyroid nodules.

Short-term Prognostic Value of Early Fluid Balance and Lactate Clearance in Patients with Acute Myocardial Infarction Combined with Cardiogenic Shock Treated with Extracorporeal Membrane Oxygenation

MIAO Guangrui, PANG Shuo, ZHOU Yuanhang, DUAN Mingxuan, BAI Linpeng, ZHANG Qingyang, ZHAO Xiaoyan, DONG Jianzeng

2023, 26(27):  3397-3402.  DOI: 10.12114/j.issn.1007-9572.2023.0126

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Background Cardiogenic shock (CS) is the leading cause of death in patients with acute myocardial infarction (AMI) , and it is important to explore the efficacy of extracorporeal membrane oxygenation (ECMO) in AMI patients combined with CS.Objective To investigate the short-term prognostic value of early fluid balance and lactate clearance in AMI patients combined with CS treated with ECMO.Methods The clinical data of 49 hospitalized AMI patients combined with CS treated with ECMO from April 2017 to December 2022 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. The included patients were divided into the survival group (n=27) and death group (n=22) according to 30-day post-ECMO outcomes. Univariate and Multivariable Logistic regression analyses were used to evaluate the influencing factors of 30-day post-ECMO death. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of 24-h fluid balance, 24-h lactate clearance and their combination for 30-day post-ECMO outcomes. Delong test was used to compare the area under the ROC curve (AUC) .Results Age, creatinine level, the proportion of offender vessel as left main or left anterior descending branch, acute kidney injury and continuous renal replacement therapy, 24-h fluid balance, 24-h lactate with ECMO in the death group were higher than the survival group, and 24-h lactate clearance was lower than the survival group (P<0.05) . Multivariate Logistic regression analysis showed that age〔OR=1.102, 95%CI (1.008, 1.205) 〕, acute kidney injury〔OR=15.888, 95%CI (1.299, 194.388) 〕, 24-h fluid balance〔OR=1.085, 95%CI (1.003, 1.174) 〕and 24-h lactate clearance〔OR=0.001, 95%CI (0, 0.096) 〕were independent influencing factors of 30-d post-ECMO outcomes in AMI patients combined with CS. The ROC analysis showed that the AUCs for 24-h fluid balance, 24-h lactate clearance and their combination in the prediction of 30-d post-ECMO outcomes in AMI patients combined with CS were 0.688〔95%CI (0.539, 0.812) , P=0.015〕, 0.707〔95%CI (0.560, 0.828) , P=0.006〕, 0.847〔95%CI (0.715, 0.934) , P<0.001〕, respectively. The AUC of their combination was higher than 24-h fluid balance (Z=2.05, P<0.05) and 24-h lactate clearance (Z=2.30, P<0.05) , respectively.Conclusion Both 24-h fluid balance and 24-h lactate clearance were associated with 30-d post-ECMO outcomes, and their combination was more effective in predicting 30-d post-ECMO death.

Association between Calf Circumference and Sarcopenia in Kidney Transplant Recipients

HUANG He, ZOU Zhizhuo, LI Qin, LIU Dong, WANG Yuqi, TAN Rongshao

2023, 26(27):  3403-3410.  DOI: 10.12114/j.issn.1007-9572.2022.0887

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Background

Sarcopenia may be associated with the long-term prognosis of renal transplant recipients, so it is essential to early and rapidly screening for sarcopenia in these patients. Studies suggest that calf circumference may be an effective indicator in early screening for sarcopenia.

Objective

To investigate the relationship between calf circumference and sarcopenia, and to explore the feasibility of using calf circumference as a predictive marker for sarcopenia in kidney transplant recipients.

Methods

We selected 80 kidney transplant recipients who were treated in the department of organ transplantation of Guangdong Second Provincial General Hospital from October 2021 to June 2022 as the subjects. Demographic information (sex, age, educational attainment, marital status) , anthropometric indicators〔height, weight, body mass index (BMI) , calf circumference, mid-arm circumference (MAC) , triceps skin-fold thickness (TSF) , arm muscle circumference (AMC) , waist circumference, hip circumference, waist-to-hip ratio〕, muscle strength indicators (grip strength, pinch strength) , body composition indicators〔appendicular skeletal muscle mass (ASM) , skeletal muscle mass index (SMI) , 50 kHz phase angle (PhA) , body cell mass (BCM) , intracellular and extracellular fluids〕 were collected. Sarcopenia was diagnosed by the Asian Working Group for Sarcopenia 2019 consensus. Kidney transplant recipients who meet the diagnostic criteria were included in the sarcopenia group, and those who do not meet the diagnostic criteria were included in the non-sarcopenia group. Demographic information, anthropometric indicators, muscle strength indicators, and body composition indicators between sarcopenia and non-sarcopenia patient groups were compared by sex. Pearson correlation analysis and Spearman rank correlation analysis were used to observe the correlation of calf circumference with diagnostic indicators of sarcopenia (ASM, SMI, grip strength) . Univariate and multivariate logistic regression analyses were used to explore the influencing factors of sarcopenia. The predictive value of calf circumference for sarcopenia in kidney transplant of male and female subjects was analyzed by using the receiver operating characteristic (ROC) curve, and the area under the curve (AUC) , sensitivity, specificity and optimal cut-off values were calculated.

Results

A total of 80 patients〔51 men (63.8%) and 29 women (36.2%) 〕 with an average age of (44.3±11.7) years were included, including 19 (23.75%) with sarcopenia, and 61 (76.25%) without. Sex-based analysis found that male patients with sarcopenia group had lower values of weight, BMI, calf circumference, MAC, TSF, hip circumference, grip strength, pinch strength, ASM, SMI, PhA, BCM, extracellular fluid and intracellular fluid than those without (P<0.05) . Female patients with sarcopenia had lower values of weight, BMI, calf circumference, waist circumference, hip circumference, waist-to-hip ratio, ASM, SMI, BCM, extracellular fluid and intracellular fluid than those without (P<0.05) . Correlation analysis showed that the calf circumference had a positive correlation with ASM, SMI and grip strength in both male kidney transplants (r_s=0.545, P<0.001; r_s=0.540, P<0.001; r_s=0.340, P=0.015) and female kidney transplants (r_s=0.499, P=0.006; r_s=0.578, P=0.001; r=0.426, P=0.021) . Multivariate Logistic regression analysis showed that calf circumference was associated with sarcopenia in kidney transplant〔OR=0.699, 95%CI (0.051, 0.975) , P=0.035〕. ROC analysis revealed that the AUC of calf circumference predicting sarcopenia in kidney transplant of male subjects was 0.799, with the optimal cut-off value, sensitivity and specificity of 33.3 cm, 83.3% and 74.4%, respectively. And the AUC of calf circumference predicting sarcopenia in kidney transplant of female patients was 0.851, with the optimal cut-off value, sensitivity and specificity of 32.2 cm, 100.0% and 59.1%, respectively.

Conclusion

Calf circumference is associated with sarcopenia and can be used as a predictive marker for early screening of sarcopenia in kidney transplant recipients. However, its predictive value needs to be verified further by large-sample cohort studies, and thus to better promote early clinical screening of sarcopenia in kidney transplant recipients to effectively improve their quality of life and prognosis.

The Effect of Modified Tibial Transverse Transport Technique in the Treatment of Wagner Grade Ⅲ and Ⅳ Diabetic Foot Patients

DONG Yanan, JIANG Xiaorui, WANG Kai, ZONG Chuanchong, LIN Guodong, LI Xiangqing, LIN Chunxiao, CHI Juntao

2023, 26(27):  3411-3416.  DOI: 10.12114/j.issn.1007-9572.2022.0822

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Background

Diabetic foot is a serious chronic complication of diabetes, tibial transverse transport (TTT) technique can promote the regeneration of vascular tissue, improve microcirculation, achieving good results in the treatment of diabetic foot ulcers, but traditional TTT technique has many complications, which needs to be improved to reduce postoperative complications.

Objective

To investigate the efficacy of modified TTT technique, that is, bone and periosteum combined transport technique, in the treatment of patients with Wagner grade Ⅲ and Ⅳ diabetic foot.

Methods

The clinical data of 117 diabetic foot patients treated with modified TTT technique in the hand and foot surgery of Yantai Yuhuangding Hospital from January, 2018 to May, 2021 were retrospectively analyzed, and the postoperative foot preservation, functional limb preservation, large amputation, ulcer healing time, complication, foot skin temperature improvement, resting pain, preoperative and postoperative CTA results were collected. The follow-up was till to March 31, 2022.

Result

The follow-up time ranged from 5.5 to 24.0 months, with an average of (14.21±4.06) months. The postoperative foot preservation rate (no amputation or amputation below ankle) was 95.73% (112/117) , the functional limb preservation rate (no amputation or minor amputation distal to midfoot) was 83.76% (98/117) , the major amputation rate (amputation above ankle) was 4.27% (5/117) , and the postoperative ulcers healed well in all patients except amputees, with an average time to healing of (9.07±2.02) weeks, ranging from 6 to 14.5 weeks. The postoperative foot skin temperature at 1, 2, 4, and 8 weeks of the patients were significantly improved compared with the preoperative period (P<0.01) ; The postoperative VAS scores of 35 patients with resting pain at 1, 2, 4, and 8 weeks compared with the preoperative period (P<0.01) ; the CTA results showed improved postoperative vascular condition, increased microvascular vessels number and reconstructed vascular network of the foot in 70.34% (94/117) of included patients postoperatively; The incidence of complication during bone handling was 11.97% (14/117) , among which the incidence of osteotomy area skin edge necrosis, deep vein thrombosis, and pin track infection was 5.98% (7/117) , 4.27% (5/117) , and 1.71% (2/117) , respectively.

Conclusion

The modified TTT technique can promote wound healing through the stimulation of lower limb microcirculation reconstruction, to alleviate resting pain and improve foot skin temperature in diabetic foot patients effectively in the short term, with low incidence of complication, providing an effective approach for the treatment of diabetic foot.

Neuropsychological Changes of Cognitive Reverters after Stroke Based on the Montreal Cognitive Assessment (MoCA) with a Double Threshold

LIU Yue, LIU Qi, DONG Hui, LIU Yaling

2023, 26(27):  3417-3422.  DOI: 10.12114/j.issn.1007-9572.2022.0885

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Background

Cognitive function is dynamic in post-stroke patients, however, there are limited studies on cognitive recovery after stroke. The definition of cognitive reverters and neuropsychological characteristics according to various definitions have not yet been investigated.

Objective

To investigate the neuropsychological characteristics of cognitive reverters after stroke based on the traditional definition and new definition according to Montreal Cognitive Assessment (MoCA) with a double threshold.

Methods

A total of 163 patients hospitalized for first onset acute ischemic stroke were recruited from the Department of Neurology of the Second Hospital of Hebei Medical University from December 2020 to February 2022 as the study subjects. All patients were assessed for cognitive function in the acute period of ischemic stroke using the MoCA at baseline. Cognitive function was assessed again at the 6-month post-stroke follow-up with the detailed neuropsychological tests refined at the same time, including the digit span task (DST) , Stroop color and word test (SCWT) , Chinese version of Boston naming test (BNT) , verbal fluency test (VFT) , clock drawing test (CDT) , and auditory verbal learning test (AVLT) . The enrolled patients were divided into the M1 group (MoCA scores <21) , M2 group (21 ≤MoCA scores≤25) and M3 group (MoCA scores≥26) according to the MoCA with adouble threshold. While the patients were also divided into the reverters 1 (R1) group, nonreverters 1 (NR1) group, R2 group and NR2 group according to the two definitions of reverters.

Results

Patients were followed up after 6 months, of which 28 were lost to follow-up and 135 were finally included in the study. The average MoCA score in the acute period of stroke was (20.1±5.1) in 135 patients. There were 40 cases in the M1 group, 61 cases in the M2 group and 34 cases in the M3 group. The scores of the MoCA, forward DST, reverse DST, total DST, Chinese version of BNT, CDT, numbers of VFT-animal, VFT-fruit and VFT-vegetable, AVLT-immediate scores, AVLT-short delay scores, AVLT-long delay scores and AVLT-recognition scores in the M2 and M3 groups 6 months after stroke were higher than the M1 group (P<0.05) , Stroop C time consuming and numbers of Stroop C errors lower than M1 group (P<0.05) . The scores of the MoCA, reverse DST, total DST, AVLT-short delay score and AVLT-long delay score in the M3 group than the M2 group (P<0.05) . 120 patients of the 135 patients with MoCA scores<26 in the acute period of ischemic stroke were selected as the cognitive reveters study subjects. Compared with the MoCA scores during the acute period of ischemic stroke, 73 patients improved ≥2 points during the follow-up period in the R1 group and 47 patients improved <2 points in the NR1 group, with a recovery rate of 60.8% (73/120) . Patients in the R1 group had lower MoCA scores in the acute period of ischemic stroke than the NR1 group, and higher MoCA scores in the follow-up period than the NR1 group (P< 0.05) . Compared with the double threshold classification of MoCA in the acute period of stroke, 50 cases had increased scores and crossed over to the R2 group and 70 cases did not cross over to the NR2 group at follow-up, with a recovery rate of 41.7% (50/120) . Patients in the R2 group had higher MoCA score in the acute period of stroke, MoCA scores in the follold-up period, reverse DST scores, total DST scores, Chinese version of BNT scores, VFT-animal, VFT-vegetable number, CDT scores, AVLT-immediate scores, AVLT-short delay scores, AVLT-long delay scores, and AVLT-recognition scores during follow-up were higher than the NR2 group, and the Stroop C time consuming was lower than the NR2 group (P<0.05) .

Conclusion

There are varying degrees of impairment in attention, visuospatial function and delayed recall in post-stroke patients. There is no significant difference in neuropsychological characteristics between reverters and nonreverters. However, the scores of reverters are higher based on the definition using double threshold for MoCA scores, which is more relevant for clinical use.

Development and Preliminary Practice of Resilience-oriented Structured Treatment and Educational Program for Adolescents with Type 1 Diabetes

LUO Dan, XU Jingjing, WANG Yubing, LI Mingzi, FORBES Angus

2023, 26(27):  3423-3429.  DOI: 10.12114/j.issn.1007-9572.2022.0807

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Background The poor control of type 1 diabetes in Chinese adolescents has brought a heavy burden to families and society. Diabetes education in China is mainly aimed at patients with type 2 diabetes, and there is a lack of self-management support programs for adolescents with type 1 diabetes.Objective To develop a resilience-oriented structured treatment and educational program for type 1 diabetic adolescents, and to verify its applicability and feasibility among Chinese adolescents with type 1 diabetes.Methods This study was conducted during January to May 2020. Guided by the diabetes resilience model, the analysis of needs of adolescents with type 1 diabetes through literature analysis and interviews, and references obtained from the available structured educational model for type 1 diabetes, a draft resilience-oriented structured treatment and educational program for adolescents with type 1 diabetes was developed, then was revised and improved according to the results of the expert consultation. After wards, potential participants were recruited by posters posted in the outpatient department and telephone to attend a trial test conducted in the First Affiliated Hospital with Nanjing Medical University to evaluate the feasibility of the program from three aspects: recruitment response rate, authenticity and acceptability.Results The final program covers 43 teaching objectives in 3 fields, including 12 in the field of perceptions, 14 in the behavioral field and 17 in the emotional field. The program adopts group teaching method, with 5-8 patients, 1 doctor and 1 nurse in each group. There were 6 classes in a course cycle. A total of 8 adolescents were recruited in the feasibility analysis, of whom 6 adolescents completed all courses. Patients said that the course content was close to life and the class atmosphere was relaxed, and their levels of self-management ability, acceptance of diabetes and emotion regulation ability were all improved after learning the program.Conclusion The resilience-oriented structured treatment and educational program has systematic contents, standardized implementation process and high feasibility, which is worthy of further clinical verification.

Correlation between C-reactive Protein to Albumin and Coronary Collateral Circulation in Patients with Unstable Angina Pectoris

CHEN Weixiang, YIN Renlin, LING Lin, ZHANG Chi, JIANG Tingbo, LIN Jia

2023, 26(27):  3430-3434.  DOI: 10.12114/j.issn.1007-9572.2023.0081

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Background

Coronary collateral circulation (CCC) reduces the degree of myocardial ischemia and improves prognosis of patients with severe coronary artery stenosis, but CCC development varies significantly among different patients. The influencing factors of CCC development still remain clear, but the increase of inflammation response and inflammatory markers is associated with CCC. The C-reactive protein to albumin ratio (CAR) is a newly reported indicator of inflammation, which has been shown in several studies to be superior to C-reactive protein (CRP) and albumin (ALB) in reflecting cardiovascular inflammation. At present, there are few studies on the correlation between CAR level and CCC development.

Objective

To investigate the correlation between CAR and CCC development in unstable angina pectoris (UAP) patients.

Methods

One hundred and thirty-five UAP patients who underwent percutaneous coronary intervention during their hospitalization in the Cardiology Department of the First Affiliated Hospital of Soochow University from December 2021 to November 2022 were enrolled as study subjects. The clinical data of the patients were collected and the CCC grade was assessed using the Rentrop grading method. The patients were divided into the well-developed CCC group (Rentrop grade 2-3, n=52) and poor-developed CCC group (Rentrop grade 0-1, n=83) according to the angiographic results. Univariate Logistic regression and multivariate Logistic regression analyses were used to explore the influencing factors of poor-developed CCC in UAP patients. Receiver operating characteristic curves (ROC curves) were plotted to evaluate the predictive value of CRP, ALB and CAR on poor-developed CCC, the area under the ROC curve (AUC) was calculated.

Results

A total of 135 UAP patients were enrolled, including 87 males and 48 females, with an average age of (65.5±7.1) years. The proportions of diabetes mellitus, smoking, CRP, and CAR of patients in the poor-developed CCC group were significantly higher than the well-developed CCC group (P<0.05) . Multivariate Logistic regression analysis results showed that CAR and diabetes mellitus were influencing factors for poor-developed CCC in UAP patients (P<0.05) . The ROC curve results of CRP, ALB, and CAR in predicting poor-developed CCC showed that the AUC of CRP, ALB, and CAR in predicting poor-developed CCC in UAP patients were 0.771〔95%CI (0.691, 0.851) 〕, 0.745〔95%CI (0.663, 0.851) 〕, 0.813〔95%CI (0.739, 0.886) 〕. The AUC of CAR in predicting poor-developed CCC was higher than CRP (Z=3.869, P<0.001) , ALB (Z=3.044, P=0.002) , the AUC of CRP in predicting poor-developed CCC was higher than ALB (Z=2.000, P=0.046) .

Conclusion

CAR and diabetes mellitus are influencing factors for poor-developed CCC in UAP patients, elevated CAR level can predict poor-developed CCC with higher predictive value than CRP and ALB.

Effects of Different Neoadjuvant Chemotherapy Regimens on Immune Indicators and Tumor Microenvironment in HER-2-positive Breast Cancer Patients

PEI Bei, CHENG Lin, XU Lingyun

2023, 26(27):  3435-3440.  DOI: 10.12114/j.issn.1007-9572.2023.0049

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Background Breast cancer is a common clinical malignant tumor, which seriously affects the health of women. Although the current targeted therapy system for breast cancer is well established, the difference in clinical efficacy between double-target therapy and single-target therapy remains unclear.Objective To explore the effects of different neoadjuvant chemotherapy regimens on the immune indicators and tumor microenvironment in HER2-positive breast cancer patients.Methods A total of 92 patients with HER-2-positive breast cancer admitted to Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University from September 2017 to September 2021 were collected and randomly divided into the study group (trastuzumab+patuzumab+docetaxel therapy, n=46) and the control group (trastuzumab+docetaxel therapy, n=46) . The clinical efficiency rate and control rate, the changes of inflammatory factors levels and immunological indicators were compared between the two groups.Results The clinical efficiency rate and control rate after treatment of the study group were higher than those of the control group (P<0.05) . The peripheral blood CD₃⁺, CD₄⁺ and CD₄⁺/CD₈⁺ levels were higher and CD₈⁺ levels was lower in the study group than those in the control group after treatment (P<0.05) , the levels of TNF-α, IFN-γ, IL-6 and IL-8 in the study group were lower than those in the control group (P<0.05) . The percentages of PD-L1-positive cells≥25% and PD-1-positive cells≥65% in the study group were higher than those in the control group, while the percentage of FoxP3-positive cells≥0.45% in the study group was lower than that in the control group.Conclusion Neoadjuvant chemotherapy of trastuzumab + patuzumab + docetaxel can effectively improve the immune indicators and tumor microenvironment of HER-2 positive breast cancer patients.

Effect of Paeonol on Improving Behavioral Dysfunction in a Mouse Model of Middle Cerebral Artery Occlusion

CHEN Xi, LUO Jianyu, KUANG Zaoyuan, XU Qin

2023, 26(27):  3441-3449.  DOI: 10.12114/j.issn.1007-9572.2022.0346

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Background

Stroke is a cardiovascular disease that seriously endangers human health, which is characterized by high prevalence, disability and mortality rates. Peony bark is the dried root bark of peony in the buttercup family, which has the effect of clearing heat and cooling blood, activating blood circulation and resolving blood stasis. Paeonol (PAE) is the main active ingredient of peony bark, has been confirmed to have neuroprotective effect under hypoglycemia and hypoxia conditions.

Objective

To observe the effect and neurobiological mechanism of gastric administration of paeonol solution on improving behavioral dysfunction caused by middle cerebral artery occlusion (MCAO) , a kind of stroke, in a mouse model.

Methods

The study was conducted from December 2019 to December 2021. Twenty SPF male C57BL/6 mice were randomized into SHAM group (n=10) and model group (MCAO group, n=10) . The MCAO model was formed by intraluminal suture method. After 24 hours of modeling, the neurological function of each group was evaluated by Longa Score. Laser Speckle Contrast Imaging was used to monitor the changes of cerebral blood flow after MCAO. TTC staining was used in the pathological examination of cerebral infarction in MCAO mice. For investigating the protective effect of PAE on behavioural dysfunction of MCAO mice, 50 SPF male C57BL/6 mice were randomly grouped into SHAM group (n=10) , model+corn oil group (n=20) , and model+PAE group (n=20) . After the verification of model stability at 24 hours following the modeling, the model+PAE group received intragastric administration of PAE and corn oil solution in a concentration of 100 mg·kg^-1· d^-1, and the other two groups were gavaged with equal amounts of corn oil. Then on the 28th day after of modelling, survival curve was plotted to assess the survival status of mice in the three groups; the neurological recovery of mice was determined using the Longa Score; the area of cerebral infarction was examined by Nissl staining. The behavioural changes in motor sensory function were tested at five time points: the day before modeling, and 7, 14, 21 and 28 days after modelling. For exploring the mechanism of PAE improving behavioural dysfunction in MCAO mice, 30 SPF male C57BL/6 mice were randomly divided into SHAM group (n=6) , model+corn oil group (n=12) and model+PAE group (n=12) . After verifying the model stability at 24 hours following the modeling, the model+PAE group received intragastric administration of PAE and corn oil solution in a concentration of 100 mg·kg^-1· d^-1, and the other two groups were gavaged with an equal amount of corn oil. The expression of interleukin 1β (IL-1β) protein in the striatum of mouse brain was measured by Western blotting on the second day after modelling to investigate whether PAE could reduce the inflammatory response in the brain during the acute period. The expression of ionized calcium-binding adapter molecule 1 (IBA1) and glial fibrillary acidic protein (GFAP) in the penumbra was measured by immunofluorescence on the 14th day after modelling.

Results

The 28-day survival rate was 66.47% for the model+corn oil group, and 81.43% for model+PAE group. Log-rank test showed that the 28-day survival curve significantly differed across SHAM group, model+corn oil group, and model+PAE group (χ²=1.436, P<0.05) The Longa Score was lower in model+PAE group than in model+corn oil group on the 28th day after modelling (P<0.05) . The differences in the expression levels of IBA1 and GFAP in brain tissues of the three groups were statistically significant (P<0.05) . Specifically, the expression levels of IBA1 and GFAP in brain tissues in SHAM group were lower than those of the other two groups (P<0.05) . The expression levels of IBA1 and GFAP in brain tissues in model+PAE group were lower than those in model+corn oil group (P<0.05) . On the second day after modelling, model+corn oil group had higher expression level of IL-1β in striatum than both SHAM group and model+PAE group (P<0.05) .

Conclusion

PAE could control the inflammatory response in the acute stage, reduce the area of acute cerebral infarction, prolong the survival time and improve the motor sensory function in the mouse model of MCAO.

Combination of Medicine and Engineering

Wearable Inertial Sensors-based Efficacy Evaluation of Comprehensive Traditional Chinese Medicine Therapy for Lumbar Disc Herniation Due to Qi-stagnation and Blood-stasis

YAO Junjie, SHANG Qiangqiang, WANG Yufeng, LI Jiahui, LIU Chang, PANG Tingting

2023, 26(27):  3450-3455.  DOI: 10.12114/j.issn.1007-9572.2022.0804

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Background

Conservative traditional Chinese medicine (TCM) treatment has clinically proven to have a clear curative effect on lumbar disc herniation (LDH) , and its mechanism of action and biomechanical effects are the hot spots in current research.

Objective

To perform a wearable inertial sensors-based gait analysis in LDH patients with qi-stagnation and blood-stasis before and after treatment, and to verify the advantages of comprehensive TCM therapy by biomechanical methods.

Methods

This study selected 40 inpatients with an admission diagnosis of LDH treated with comprehensive TCM therapy from Tuina Department, the Affiliated Hospital of Changchun University of Chinese Medicine from June 2020 to December 2021. The patients' age, gender, the lower limb with pain, baseline body mass index, hospitalization time and pre- and post-treatment scale scores for low back pain were collected. Gait parameters were collected by wearable inertial sensors at pre- and post-treatment.

Results

Among the 40 patients, 18 were males and 12 were females. Eighteen patients had pain in the left lower limb, 8 had pain in the right lower limb, and the other 14 had pain in both lower limbs. Patients had a mean age of (52.3±15.2) years, a mean body mass index of (25.2±4.2) kg/m², and a mean length of hospitalization of (17.5±6.2) days. The treatment was effective or marketed effective in 35 cases, ineffective in 5 cases, achieving an overall response rate of 87.5%. The Visual Analogue Scale score and Oswestry Disability Index decreased, and the Japanese Orthopaedic Association Score increased after treatment compared with the baseline levels (P<0.05) . After treatment, the patient's cadence, speed, stride length, gait cycle, swing phase percentage, shank and foot shock impact increased, and the stance phase percentage decreased (P<0.05) . The range of motion of hip abduction and adduction, hip rotation, knee varus and valgus, knee rotation and ankle rotation decreased (P<0.05) . Increased pelvic obliquity index, pelvic tilt index, hip abduction and adduction degrees, hip flexion and extension degrees, hip rotation index, knee rotation index, ankle inversion and eversion degrees, ankle flexion and extension index, and ankle rotation index were also found after treatment (P<0.05) . No toxic or adverse events occurred during the treatment. Five cases had repeated symptoms or were rehospitalized during the follow-up.

Conclusion

Comprehensive TCM therapy can obviously relieve the pain, improve functional disorders and increase the gait dynamic stability in patients with LDH due to qi-stagnation and blood-stasis, which is a safe and effective conservative treatment option.

Effect of High Intensity Laser Combined with Physiotherapy Scoliosis Specific Exercise Therapy on Ultrasound Morphology of Multifidus Muscles in Idiopathic Scoliosis Patients with Low Back Pain

SUN Xiaolei, LEI Xiaolong, LIN Jiasheng, LI Keliang, GUO Ao, ZHANG Xiaohui

2023, 26(27):  3456-3462.  DOI: 10.12114/j.issn.1007-9572.2023.0171

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Background

Adolescent idiopathic scoliosis (AIS) is a progressive three-dimensional skeletal deformity that affects spinal mobility and trunk symmetry. It was previously believed that AIS was not accompanied with pain, but recent studies have shown that approximately 31.5% of the patients complain of low back pain, which may due to factors such as paravertebral muscle imbalance and fatigue.

Objective

To observe morphological changes of paravertebral multifidus muscles at the top of the main curvature after high energy laser therapy (HILT) combined with physiotherapy scoliosis specific exercise (PSSE) in AIS patients with low back pain by using musculoskeletal ultrasound. and evaluate the clinical effect of treatment on the correction of paravertebral muscle imbalance.

Methods

A total of 30 patients with AIS RigoE1 admitted to the Scoliosis Correction Center of the Fifth Hospital of Harbin from December 2020 to December 2021 were selected for a randomized single-blind controlled trial and divided into the experimental group (n=15) and control group (n=15) , the experimental group was treated with HILT combined with PSSE, and the control group was only treated with HILT. Musculoskeletal ultrasound, visual analogue scale (VAS) scores, range of motion of the patient's lumbar joints and Roland-Morris lumbar spine dysfunction questionnaire (RDQ) were performed before and 4 weeks after treatment in both groups. Pearson correlation analysis was used to investigate whether there was a correlation between the changes in the multifidus muscles after treatment and the treatment effect.

Results

The cross-sectional area of the convex side of multifidus muscles, anterior flexion, left lateral flexion, left rotation and right rotation of the experimental group were higher than those of the control group after treatment (P<0.05) , the cross-sectional area and thickness of multifidus muscles on the concave side, the cross-sectional area and thickness ratios of multifidus muscles on the concave and convex sides, extension after treatment were higher than those before treatment in the experimental group (P<0.05) . VAS scores and RDQ scores after treatment were lower than those before treatment, and anterior flexion, left lateral flexion, right lateral flexion, left rotation and right rotation were higher than those before treatment (P<0.05) in both two groups. The extension after treatment was lower than that before treatment in the control group (P<0.05) . Pearson correlation analysis showed that the cross-sectional area ratio of multifidus muscles on the concave and convex sides was negatively related with right rotation of the lumbar spine after treatment in the experimental group (r=-0.660, P<0.01) , the thickness ratio of the concave and convex sides of multifidus muscles was negatively related with right flexion of the lumbar spine (r=-0.614, P<0.05) .

Conclusion

HILT combined with PSSE can change the morphology of the multifidus muscles on the concave side of the parietal vertebrae of scoliosis, reduce low back pain, increase lumbar spine mobility, reduce lumbar spine dysfunction and improve activities of daily living; the use of HILT alone can effectively relieve low back pain caused by scoliosis, although it has no significant effect on the morphological changes of the multifidus muscles. Balancing the morphology of the multifidus muscles on both sides of the spine has a positive effect on improving the lateral flexion and rotation of the lumbar spine.