Table of Content

20 October 2023, Volume 26 Issue 30

Previous Issue    Next Issue

Guidelines Interpretation

Interpretation of ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in Children and Adolescents with Diabetes

CHENG Jingwei, QIAO Junjun, YIN Zhen, HU Junpeng, WANG Qinghe, LIU Yangqing, WANG Yanfang

2023, 26(30):  3719-3724.  DOI: 10.12114/j.issn.1007-9572.2023.0327

Asbtract ( )   HTML ( )   PDF (1028KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Regular physical activity is a cornerstone of diabetes management, and more precise guidance on exercise prescriptions is needed in children and adolescents with diabetes due to the complexity of glycemic changes, however, there are relatively few guidelines for this population. As the continuous exploration of experts and scholars in this field, after five years, the International Society for Pediatric and Adolescent Diabetes (ISPAD) updated its guidelines on exercise for children and adolescents with diabetes in 2022. The guidelines target the service population more precisely to the children and adolescents with type 1 diabetes and provide comprehensive guidance from the perspectives of exercise types, exercise timing, blood glucose fluctuations during exercise, insulin adjustment and nutritional supplementation. This article interprets the main contents and key updates of the 2022 ISPAD guidelines, aiming to provide more scientific exercise prescriptions for children and adolescents with diabetes in China.

Original Research

Research Status of Patient-reported Outcome Assessment Tools for Obstructive Sleep Apnea

WEI Mengyu, WANG Jiajia, ZHANG Yingying, LI Chunyang, LI Jiansheng

2023, 26(30):  3725-3733.  DOI: 10.12114/j.issn.1007-9572.2023.0141

Asbtract ( )   HTML ( )   PDF (835KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Obstructive sleep apnea (OSA) is a common sleep-related respiratory disorder that can easily induce or aggravate a variety of diseases, often causing different levels of decline in the patient's quality of life. Patient-reported outcome (PRO) assessment tools provide effective means for evaluating both quality of life and clinical efficacy. There are numerous OSA-PRO assessment tools available, primarily developed in foreign countries, mainly covering domains such as symptoms, daily activities, social activities, and psychological emotions, with items ranging in number from one to 84, and Likert scale as the main type of response scale. The development and evaluation of these tools employ the classical test theory (CTT). We provide the following recommendations for future research: evaluating the psychometric properties and methodological quality of OSA-PRO assessment tools; combining CTT with modern test theory to develop, revise, and evaluate OSA-PRO assessment tools; strengthening the research on the minimal clinically important difference of OSA-PRO assessment tools; developing OSA-PRO assessment tools highlighting the clinical efficacy of traditional Chinese medicine.

Outcome Indicators Analysis of Randomized Controlled Trials of Acupuncture for Obstructive Sleep Apnea Hypopnea Syndrome in the Past Decade

QU Hui, LI Huan, TANG Ruohan, DU Yuzheng, ZHAO Qi

2023, 26(30):  3734-3739.  DOI: 10.12114/j.issn.1007-9572.2023.0207

Asbtract ( )   HTML ( )   PDF (837KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Acupuncture is one of the non-pharmacological methods for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). The progression of research evidence on acupuncture for OSAHS to high quality islimited by the defects in the outcome indicators of randomized controlled trials (RCTs) of acupuncture for OSAHS. Therefore, it is of reference value to analyze the outcome indicators of RCTs of acupuncture for OSAHS.

Objective

To analyze the outcome indicators of RCTs of acupuncture for OSAHS in the past 10 years, clarify the existing problems and provide suggestions for the guidance of further studies.

Methods

CNKI, Wanfang Data, VIP, SinoMed, PubMed, Embase, Cochrane Library, Web of Science, Clinical Trials.gov were searched for the RCTs of acupuncture for OSAHS from 2012-01-01 to 2022-11-18 with a combination of subject terms and free terms. The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of the included literature and sort out outcome indicators.

Results

A total of 2 085 relevant papers were obtained from the preliminary search, and 12 papers were included after duplicating and multiple screening, and the outcome indicators were classified into traditional Chinese medicine (TCM) syndrome indicators, clinical symptom indicators, clinical efficacy indicators, neuroimaging indicators, polysomnography indicators, other examination indicators, serological indicators, life quality indicators and safety indicators. The most frequently reported outcome indicators were polysomnography indicators, followed by clinical symptom indicators.

Conclusion

The outcome indicators of RCTs of acupuncture for OSAHS have problems such as indistinguishable priorities, various clinical symptom indicators, inadequate application of serological indicators, limited safety evaluation, lack of standard for TCM characteristic syndrome differentiation indicators and long-term efficacy and economic evaluation. It is recommended to conduct more high-quality researches to strengthen the connection between TCM characteristic syndrome differentiation indicators, modern science and technology indicators and clinical studies, unify standard of syndrome differentiation of OSAHS, strengthen the awareness of conducting economic and safe clinical researches, so as to establish a core set of indicators of acupuncture treatment for OSAHS.

Correlation of Metabolic Indexes as Predictors with Obstructive Sleep Apnea

WEN Wen, ZHANG Kainan, CHEN Yulan, LI Yu, ZHANG Xiangyang

2023, 26(30):  3740-3747.  DOI: 10.12114/j.issn.1007-9572.2023.0168

Asbtract ( )   HTML ( )   PDF (973KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Obstructive sleep apnea (OSA) has a high prevalence, and it has been shown to be an independent risk factor for various diseases. Therefore, it is important to strengthen screening for population at highrisk of OSA. OSA patients are prone to combine with lipid metabolism disorders, but it remains unclear whether the atherogenic index of plasma (AIP), visceral adiposity index (VAI), lipid accumulation product (LAP), cardiometabolic index (CMI), and Chinese visceral adiposity index (CVAI), which are used asmetabolic indexes, can be used to predict OSA.

Objective

To analyze the correlation between metabolic indexes and OSA, and evaluate the predictive efficacy of each metabolic index through a case-control study.

Methods

A total of 2 968 inpatients with suspected OSA and aged ≥18 years who completed polysomnography (PSG) in the First Affiliated Hospital of Xinjiang Medical University from March 2017 to June 2022 were selected, with 2 850 patients finally included based on the inclusion and exclusion criteria and divided into the OSA group 〔apnea-hypopnea index (AHI) ≥5 times/h, n=2 193〕 and non-OSA group (AHI<5 times/h, n=657) according to the AHI. The clinical data and laboratory test results of these patients were collected through the electronic medical record system. Univariate and multivariate Logistic regression analyses were used to investigate the correlation of AIP, VAI, LAP, CMI, and CVAI with OSA. The receiver operating characteristic (ROC) curve was plotted to analyze the efficacy of metabolic indexes in predicting OSA. A gender-stratified analysis was performed to explore the relationship between metabolic indexes and OSA in different populations.

Results

Age, gender (male proportion), neck circumference, height, total cholesterol, triacylglycerol, AHI, AIP, VAI, LAP, CMI, and CVAI were significantly higher in the OSA group than the non-OSA group, high-density lipoprotein cholesterol (HDL-C), mean oxygen saturation and minimum oxygen saturation were significantly lower than the non-OSA group (P<0.05). After dividing the five metabolic indexes into quartiles (Q1 to Q4), them ultivariate Logistic regression analysis showed that AIP〔OR=2.241, 95%CI (1.689, 2.972), P<0.001〕, VAI〔OR=2.517, 95%CI (1.919, 3.301), P<0.001〕, LAP〔OR=2.313, 95%CI (1.761, 3.038), P<0.001〕, CMI〔OR=2.732, 95%CI (2.054, 3.633), P<0.001〕, and CVAI〔OR=6.060, 95%CI (4.411, 8.324), P<0.001〕 were associated with the risk of OSA (P<0.05). Further analysis stratified by gender showed that in female patients, AIP, VAI, LAP, CMI, and CVAI were associated with the risk of OSA (P<0.05) ; in male patients, CMI, LAP, and VAI were not associated with OSA (P>0.05), but AIP and CVAI were associated with OSA (P<0.05). The areas under the ROC curves (AUCs) of AIP, VAI, LAP, CMI, and CVAI for predicting OSA were〔0.593, 95%CI (0.568, 0.618) 〕〔0.607, 95%CI (0.583, 0.632) 〕〔0.594, 95%CI (0.569, 0.619) 〕〔0.616, 95%CI (0.591, 0.640) 〕, and〔0.728, 95%CI (0.706, 0.751) 〕, respectively.Further analysis stratified by gender for the clarification of the predictive efficacy of five metabolic indexes for OSA showed that the AUCs of the five metabolic indices for predicting OSA were higher in the female population than the total population, and the AUCs of the five metabolic indexes were lower in the male population than the total population. The AUC of CVAI was higher than other indexes in the total population, male and female populations (AUC=0.728 for the overall population, AUC=0.764 for the female population, AUC=0.681 for the male population) .

Conclusion

As the quartiles of AIP, VAI, LAP, CMI, and CVAI increase, the risk of OSA rises. CVAI has a better predictive efficacy for OSA than other indexes, therefore, CVAI may be used as a predictor for screening of population at high risk of OSA.

The Level of Adipokine Metrnl and Its Relationship with Inflammation and Insulin Resistance in Patients with Obstructive Sleep Apnea Syndrome

HU Jiayu, REN Lijue, JIN Huanhuan, SUN Tingting, JIN Meina, ZHOU Xueli, WEI Cuiying

2023, 26(30):  3748-3752.  DOI: 10.12114/j.issn.1007-9572.2023.0214

Asbtract ( )   HTML ( )   PDF (792KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Obstructive sleep apnea syndrome (OSAS) patients have severe multisystem metabolic disorders in the body, with a high comorbidity rate with various metabolic diseases and poor prognosis. The adipokine Metrnl is a newly identified target for regulating lipid and glycolipid metabolism. The correlation of Metrnl with OSAS and OSAS-related metabolic disorders has been rarely reported.

Objective

To observe the differences of adipokine Metrnl in patients with OSAS, and explore its relationship with inflammation and insulin resistance caused by OSAS.

Methods

A total of 119 participants who were hospitalized and physically examined in the geriatric department of the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology from 2021 to 2022, were selected and divided into the mild OSAS group (n=57), moderate-to-severe OSAS group (n=26) and control group (n=62) according to the results of standard polysomnography monitoring. General data of the 3 groups was collected, including fasting blood glucose (FBG), fasting insulin (FINS), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), glycosylated hemoglobin A_1c (HbA_1c), uric acid (UA), Metrnl, nuclear factor-κB (NF-κB), IL-6, TNF-α, IL-10 and IL-4 levels. The homeostatic model assessment for insulin resistance (HOMA-IR) was used to assess insulin resistance.

Results

BMI in the moderate-to-severe OSAS group was higher than the control group and mild OSAS group (P<0.05) ; FINS level in the moderate-to-severe OSAS group was higher than the mild OSAS group and control group, and FINS level in the mild OSAS group was higher than the control group (P<0.05) ; Metrnl level of the moderate-to-severe OSAS group was lower than the mild OSAS group and control group, and Metrnl level in the mild OSAS group was lower than the control group (P<0.01) ; NF-κB, TNF-α, IL-6, and HOMA-IR in the OSAS group were higher than the control group, TNF-α and HOMA-IR in the moderate-to-severe OSAS group were higher than the mild OSAS group and control group, TNF-α and HOMA-IR in the mild OSAS group were higher than the control group (P<0.01), IL-10 in the OSAS group was lower than the control group (P<0.01). Partial correlation analysis showed that Metrnl level was negatively correlated with NF-κB (r=-0.30), IL-6 (r=-0.40), TNF-α (r=-0.37), HOMA-IR (r=-0.36), FBG (r=-0.32), HbA_1c (r=-0.33) and AHI (r=-0.51), and positively correlated with IL-10 (r=0.27) (P<0.05). Multiple linear regression analysis showed that IL-6, TNF-α, HOMA-IR were independent influencing factors for Metrnl level (P<0.05) .

Conclusion

The expression level of Metrnl is reduced in OSAS patients and negatively correlated with the severity of OSAS. HOMA-IR, IL-6, TNF-α are independent influencing factors for Metrnl level in OSAS patients.

The Efficacy of Continuous Airway Positive Pressure Ventilation on OSA Complicated with GERD: an Observational Study

DENG Jingjing, LI Xia, XUE Qian, DENG Lihua, WANG Jingtong

2023, 26(30):  3753-3758.  DOI: 10.12114/j.issn.1007-9572.2023.0151

Asbtract ( )   HTML ( )   PDF (842KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA) are both common clinical diseases with the increasing prevalence year by year. There is still controversy as to whether continuous airway positive pressure ventilation (CPAP) can improve both OSA and GERD at the same time.

Objective

To investigate the efficacy of CPAP on OSA complicated with GERD.

Methods

A total of 169 patients diagnosed with OSA complicated with GERD in the geriatric and respiratory departments of Peking University People's Hospital from September 2020 to January 2023 were selected as research subjects, their general data were collected. The included patients were followed up regularly with the endpoint of GERD remission or 8 weeks of treatment, excluding those with no treatment compliance. The included patients were divided into the patients without proton pump inhibitor (PPI) and patients with PPI according to whether they received PPI. The patients without PPI were further divided into the CPAP group (n=43) and non-treatment group (n=53), the patients with PPI were divided into the CPAP+PPI group (n=32) and PPI group (n=41) according to whether they received CPAP treatment. The Kaplan-Meier method was used to plot the survival curves of GERD remission rates in the CPAP group and non-treatment group, and the differences were compared by Log-rank test. Multivariate Cox proportional risk regression model was used to explore the effects of CPAP on GERD remission in patients with OSA complicated with GERD.

Results

The median remission time to remission was 6 weeks in the CPAP group and 7.5 weeks in the non-treatment group; the cumulative GERD remission rate in the CPAP group was higher than the non-treatment group and the difference was statistically significant (χ²=4.182, P=0.041). The median remission time to remission was 3.9 weeks in the CPAP+PPI group and 6.1 weeks in the PPI group; the cumulative GERD remission rate in the CPAP+PPI group was higher than the PPI group and the difference was statistically significant (χ²=14.333, P<0.001). The results of the multivariate Cox proportional risk regression showed that CPAP was an influential factor for GERD remission in patients with OSA complicated with GERD without PPI〔HR=2.360, 95%CI (1.044, 5.338), P<0.05〕, CPAP was an influential factor for GERD remission in patients with OSA complicated with GERD treated with PPI〔HR=6.123, 95%CI (2.562, 14.635), P<0.05〕.

Conclusion

CPAP can improve GERD symptom in patients with OSA complicated with GERD. The efficacy of CPAP+PPI on GERD is superior to PPI alone.

Clinical Study on the Combination of Xiaotan Huayu Tongyi Granules, Channel Kaijie Pills and Chemotherapy in the Treatment of Esophageal Cancer

LI Jilei, LI Honglin, XU Yanchao, LIU Yanan, CHEN Mengli, SHAO Shuai, MA Chunzheng

2023, 26(30):  3759-3764.  DOI: 10.12114/j.issn.1007-9572.2023.0185

Asbtract ( )   HTML ( )   PDF (798KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Esophageal cancer threatens the life and health of patients due to its complex etiology and poor prognosis, and individualized combination treatment of traditional Chinese medicine and western medicine has certain advantages.

Objective

To observe the clinical efficacy of the combination of Xiaotan Huayu Tongyi Granules, Channel Kaijie Pills and CF regimen (fluorouracil+cisplatin) on the treatment of stage Ⅲ-Ⅳ phlegm-stasis interjunction esophageal squamous cell carcinoma.

Methods

A total of 99 patients with phlegm-stasis interjunction type esophageal squamous cell carcinoma diagnosed and treated in Henan Hospital of Traditional Chinese Medicine, Anyang Cancer Hospital and Henan Cancer Hospital from February 2020 to February 2021 were selected as the study objects and randomly divided into the control group, treatment groupⅠand treatment groupⅡ, with 33 cases in each group. The control group was treated with CF regimen, the treatment groupⅠwas treated with Xiaotan Huayu Tongyi Granules combined with CF regimen, and the treatment groupⅡ was treated with the combination of Xiaotan Huayu Tongyi Granules, Channel Kaijie Pills and CF regimen. A total of 4 courses of chemotherapy were administered with 21 days as a course. The differences in TCM syndrome score, quality of life score, Karnofsky Performance Status (KPS) score, lesion remission rate, carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC) and toxic side effects among the three groups were observed.

Results

There was no significant difference in gender, age, body mass and tumor staging among the three groups (P>0.05). Compared with pre-treatment, retrosternal chest pain, nausea and vomiting, mucus and vomit, vomitus scores and total score were reduced in the three groups, dysphagia, oligophagia and dry stool scores were reduced in the control group and treatment group Ⅱafter treatment (P<0.05) ; quality of life score and KPS score were increased, CEA and SCC levels were reduced in the three groups after treatment (P<0.05). After treatment, dysphagia, retrosternal chest pain, nausea and vomiting, vomitus, oligophagia, dry stool scores and total score in treatment groupⅡwere lower than the control group and treatment groupⅠ, and mucus and vomit score was lower than the control group (P<0.05) ; quality of life score and KPS score in both treatment groups were higher than the control group, KPS score in the treatment groupⅡwas higher than the treatment groupⅠ, CEA and SCC levels in the treatment groupⅡwere lower than the treatment groupⅠand control group (P<0.05). There was no statistically significant difference in the lesion remission rate and toxic side effects among the three groups after treatment (P>0.05) .

Conclusion

The combination of Xiaotan Huayu Tongyi Granules, Channel Kaijie Pills and CF regimen in the treatment of stageⅢ-Ⅳphlegm-stasis interjunction esophageal squamous cell carcinoma can improve clinical symptoms, reduce the levels of tumor markers, and improve the quality of life of patients.

Clinical Observation of Dingxiang Guanshitong Hanhua Pills Alone and Its Combination with Fugui Guanshitong Granules in the Treatment of Advanced Esophageal Cancer

ZHENG Yuling, ZHANG Yaling, LIU Huaimin, XU Yanchao, JIA Xiaolin, LI Junsai, HE Wenlong, TONG Xinduo, QIN Shanwen, ZHANG Lihan

2023, 26(30):  3765-3771.  DOI: 10.12114/j.issn.1007-9572.2023.0177

Asbtract ( )   HTML ( )   PDF (473KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Traditional Chinese medicine (TCM) has become an important option for patients with advanced esophageal cancer (EC) who are not able to undergo surgery, radiotherapy, chemotherapy, or with disease progression after chemotherapy. The purpose of this study is to investigate the application effects of Dingxiang Guanshitong Hanhua Pills alone and its combination with Fugui Guanshitong Granules, in order to improve the quality of life of patients with advanced EC, and provide an effective TCM treatment schemes for EC.

Objective

To evaluate the effects of Dingxiang Guanshitong Hanhua Pills alone and its combination with Fugui Guanshitong Granules on survival rate and quality of life of patients with EC after 6 weeks of treatment.

Methods

A total of 109 patients with advanced EC admitted to nine centers such as the First Affiliated Hospital of Henan University of CM, Linzhou Hospital of Traditional Chinese Medicine and Jia County Hospital of Traditional Chinese Medicine from January 2020 to April 2021 were selected as the research objects and divided into the control group, experimental group 1 and experimental group 2 by block randomization method. The control group received Danggui Buxue Decoction and Guizhi Renshen Decoction Granules, the experimental group 1 received Fugui Guanshitong Granules and Dingxiang Guanshitong Hanhua Pills, the experimental group 2 received Dingxiang Guanshitong Hanhua Pills, with the course of 6 weeks in the above three groups. The survival rate after 6 weeks of treatment, Quality of Life (QOL) score, Karnofsky Performance Status (KPS) score, TCM syndrome score (dysphagia, poststernal chest pain, mucus vomiting, loss of appetite, fatigue) before and after treatment of the three groups were compared, and safety evaluation was conducted.

Results

After 6 weeks of treatment, the survival rate was 72.7% in the control group, 88.6% in the experimental group 1, and 86.8% in the experimental group 2, and there was no statistically significant difference in the survival rates among the three groups after 6 weeks of treatment (χ²=4.036, P=0.133). There was no interaction effect of group and time on QOL score, KPS score, and TCM syndrome score (P_interaction>0.05). The main effect of group was not significant on QOL score, KPS score and TCM syndrome score (P_interclass>0.05). The main effect of time was significant on QOL score, KPS score and TCM syndrome score (P_time<0.05). There was an interaction effect of group and time on mucus vomiting score (P_interaction<0.05), the scores of loss of appetite and mucus vomiting in the experimental group 2 were significantly lower than the experimental group 1 (P<0.05). Adverse events in the three groups included diarrhea, fever, dry mouth, sore throat, inability to eat, lung infection, without serious complications. There was no significant difference in the incidence of adverse events among the three groups (χ²=0.063, P=0.969) .

Conclusion

All three treatment schemes can relieve the clinical symptoms and improve the quality of life of the patients with advanced EC. Moreover, the efficacy of Dingxiang Guanshitong Hanhua Pills alone on appetite loss and mucus vomiting was better than that of Danggui Buxue Decoction and Guizhi Renshen Decoction Granules and the combination of Dingxiang Guanshitong Hanhua Pills and Fugui Guanshitong Granules.

Effect of Consolidation Chemotherapy on Prognosis of StageⅡ-Ⅲ Esophageal Squamous Cell Carcinoma Patients Treated with Definitive Concurrent Chemotherapy and Radio-therapy

YAN Ke, WEI Wanyi, LI Shuguang, YAO Weinan, DONG Jing, WANG Xiaobin, ZHANG Xueyuan, YANG Jie, SHEN Wenbin, ZHU Shuchai

2023, 26(30):  3772-3779.  DOI: 10.12114/j.issn.1007-9572.2023.0202

Asbtract ( )   HTML ( )   PDF (885KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The improvement efficacy of consolidation chemotherapy after definitive concurrent chemotherapy and radio-therapy (CCRT) on the prognosis of patients with locally advanced esophageal squamous cell carcinoma (ESCC) remains controversial. In addition, there is a lack of nutritional risk screening tools which can consistently and accurately predict the survival of patients with esophageal cancer.

Objective

To investigate the effect of consolidation chemotherapy on the prognosis of patients with locally advanced ESCC receiving definitive CCRT.

Methods

A total of 223 patients with ESCC who received definitive CCRT in the department of radiotherapy, the Fourth Hospital of Hebei Medical University from January 2013 to December 2018 were selected as the research objects and divided into the simple CCRT group (n=87) and combined consolidation chemotherapy group (n=136) according to chemoradiotherapy regimen adopted by the patients. General data, ECOG score, tumor site, tumor length, TNM stage, radiotherapy dose, irradiation mode and chemotherapy regimen of the included patients were collected by electronic medical record system. Nutritional Risk Screening 2002 (NRS 2002) was used to score the nutritional status of the patients before chemoradiotherapy. Efficacy evaluation was performed within 1 month after CCRT, including complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). Patients were followed up by telephone (completed by the follow-up center) and outpatient review until 2022-09-30, with overall survival (OS), local relapse-free survival (LRRFS) and distant metastasis-free survival (DMFS) collected. Survival curves of OS, LRRFS and DMFS were plotted by Kaplan-Meier method and compared by Log-rank test. Univariate and multivariate Cox risk regression models were used to explore the influencing factors of patient prognosis.

Results

There was no significant difference in baseline data between the simple CCRT group and combined consolidation chemotherapy group (P>0.05). There was no significant difference in the rates of OS, LRRFS and DMFS between the two groups (χ²=1.942, 0.743, 1.272; P=0.163, 0.389, 0.259). There were significant differences in the rates of OS, LRRFS and DMFS between patients with NRS 2002 score <3 (n=172) and patients with NRS 2002 score≥3 (n=51) before treatment (χ²=6.585, 4.858, 7.814; P=0.010, 0.028, 0.005). Multivariate Cox proportional hazard regression analysis showed that TNM stage and NRS 2002 score were influencing factors of OS and DMFS (P<0.05), irradiation mode was an influencing factor of LRRFS and DMFS (P<0.05), and clinical efficacy was an influencing factors of OS, LRRFS and DMFS (P<0.05). Stratified analysis showed that in patients with TNM stage Ⅱ and clinical efficacy of CR, the OS rates in the combined consolidation chemotherapy group (n=74, n=33) were significantly higher than those in the simple CCRT group (n=43, n=28), with statistically significant differences (χ²=4.811, 3.932; P=0.028, 0.047) .

Conclusion

Consolidation chemotherapy did not improve the prognosis of stageⅡ-Ⅲ ESCC patients after definitive CCRT, but may bring survival benefits for patients with early clinical stage, good response and nutritional status. As a nutritional risk screening tool, NRS 2002 has significant predictive value for the long-term survival of patients with locally advanced ESCC after chemoradiotherapy.

Improvement of Nutritional Status of Elderly Patients with Severe Obstruction Esophageal Carcinoma by Image-guided Photodynamic Therapy

ZHANG Ming, XU Jing, SUN Zhenhua, ZHAO Wenhao, MA Yingqian, ZHANG Jianqiao, SHEN Haiping

2023, 26(30):  3780-3784.  DOI: 10.12114/j.issn.1007-9572.2023.0188

Asbtract ( )   HTML ( )   PDF (901KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Esophageal cancer is one of the most aggressive gastrointestinal tumors. Advanced esophageal carcinoma is mainly associated with dysphagia. Most elderly patients with severe obstruction esophageal carcinomacannot tolerate anesthesia and invasive treatment due to comorbidities, while the failure to improve dysphagia in the short term will seriously affect the nutritional status, life quality and prognosis of patients.

Objective

To explore the safety and efficacy of image-guided photodynamic therapy (IGPDT) under local anesthesia for short-term improvement of obstruction and nutritional status in elderly patients with severe obstruction esophageal carcinoma.

Methods

A total of 24 elderly patients with severe obstruction esophageal carcinoma admitted to Hebei General Hospital from March 2020 to December 2021 were selected for IGPDT in the prospective, single-arm, self-control study. The upper boundary of the lesion was located by endoscopy and marked with metal tissue clips, the lower boundary of the lesion was located by CT and esophagography before treatment. During the treatment, the fiber of laser treatment was delivered to the lesion site under the guidance of X-ray fluoroscopy during treatment. The Stooler dysphagia score was evaluated before, 1 week and 1 month after operation. The nutritional status of patients was evaluated by nutritional risk screening 2002 (NRS 2002) score, hemoglobin, BMI, albumin and prealbumin before and 2 months after operation. The swallowing quality of life scale (SWAL-QOL) was used to evaluate the quality of life in patients.

Results

All patients achieved partial response (PR) at 1 month postoperative efficacy evaluation. The Stooler dysphagia scores at 1 week and 1 month after IGPDT were significantly lower than that before operation (P<0.001). BMI, albumin and prealbumin at 2 months after operation were significantly increased than that before operation (P<0.05). The total score and scores of different dimensions in SWAL-QOL at 2 months after operation were significantly higher than those before operation, including psychological burden, appetite, eating time, fear of eating and swallowing symptoms (P<0.05). 92% (22/24) of the patients presented with grade 1-2 mild fever, and most of them could be relieved on their own. 83% (20/24) of the patients presented with grade 1-2 pain at the site of operation at 1-2 days after surgery but could be relieved by themselves. No esophageal fistula occurred in all patients during the operation, and no serious adverse effects of grade 3 or above occurred.

Conclusion

IGPDT has the advantages of easy operation, excellent efficacy and safety, and short-term improvement of nutritional status in patients, which can be used as a novel photodynamic therapy for patients with severe obstruction esophageal carcinoma cannot be passed by endoscopy.

Long-term Prognosis Analysis and Influencing Factors of Concurrent Chemotherapy and Radio-therapy for Cervical and Upper Thoracic Esophageal Squamous Cell Carcinoma

YAN Ke, WEI Wanyi, DENG Wenzhao, SHEN Wenbin, LI Shuguang, DU Xingyu, ZHANG Xueyuan, YANG Jie, ZHU Shuchai

2023, 26(30):  3785-3790.  DOI: 10.12114/j.issn.1007-9572.2023.0241

Asbtract ( )   HTML ( )   PDF (832KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The incidence of cervical and upper thoracic esophageal cancer is relatively low, with difficulties and controversies of mode in treatment, lack of convenient and accurate prognostic biomarkers, and poor overall prognosis.

Objective

To investigate the long-term prognosis of patients with cervical and upper thoracic esophageal squamous cell carcinoma under concurrent chemotherapy and radio-therapy (CCRT) .

Methods

Patients with cervical and thoracic upper esophageal cancer who received CCRT in the Department of Radiotherapy of the Fourth Hospital of Hebei Medical University from January 2013 to December 2017 were selected as the research subjects. General data, Eastern Cooperative Oncology Group (ECOG) score, tumor site, tumor length, TNM stage, radiotherapy dose, irradiation mode, chemotherapy regimen, toxic and side effects were collected by electronic medical record system, and neutrophil to lymphocyte ratio (dNLR) was calculated. The patients were divided into the dNLR<2.15 group (64 cases) and dNLR≥2.15 group (42 cases) according to dNLR. The patients were followed up, radiotherapy was reviewed once every 3 months for 1 year, once every 6 months for 2 to 5 years, and once every 1 year after 5 years, and overall survival (OS), progression-free survival (PFS), local relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) were collected. Survival curves of OS, LRRFS and DMFS were plotted by Kaplan-Meier method. The single factor analysis of OS, PFS, LRRFS and DMFS was performed by Log-rank test. Multivariate Cox proportional hazard regression model was used to explore the influencing factors of OS, PFS, LRRFS and DMFS.

Results

As of the last follow-up, the OS rates at 3, 5 and 7 years were 55.7%, 43.0% and 37.8%, with a median OS of 47.5〔95%CI (29.4, 65.6) 〕months; the rates of PFS at 3, 5 and 7 years were 45.3%, 37.7% and 31.1%, with a median PFS of 30.7〔95%CI (21.1, 40.3) 〕months; the LRRFS rates in 3, 5 and 7 years were 50.9%, 41.4% and 33.5%, with a median LRRFS of 43.5〔95%CI (21.6, 65.4) 〕months; the DMFS rates at 3, 5 and 7 years were 49.1%, 38.6% and 34.4%, with a median DMFS of 34.7〔95%CI (20.7, 48.7) 〕months. Multivariate Cox proportional hazard regression analysis showed that TNM stage and irradiation mode were influencing factors of OS, PFS, LRRFS and DMFS (P<0.05), gender was an influencing factor of LRRFS (P<0.05), and dNLR was an influencing factor of PFS and DMFS (P<0.05). There were 10 cases, 25 cases, 32 cases, 9 cases and 11 cases of grade 2 and above acute radiation pneumonitis, acute radiation esophagitis, leukopenia, anemia and thrombocytopenia, respectively.

Conclusion

The long-term prognostic survival outcome of CCRT for cervical and upper thoracic esophageal squamous cell carcinoma was satisfactory and well tolerated. Local recurrence was the main failure pattern. Elective lymphatic drainage irradiation can significantly improve the prognosis of patients, which can be promoted clinically and dNLR has a predictive effect on long-term survival.

The Prediction Value of (Neutrophil+Monocyte) /Lymphocyte Ratio on In-hospital Mortality of Heart Failure Patients

MA Yanyan, REN Fuxian, WANG Yu, GAO Dengfeng

2023, 26(30):  3791-3796.  DOI: 10.12114/j.issn.1007-9572.2023.0198

Asbtract ( )   HTML ( )   PDF (862KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Heart failure (HF) is known to be one of the major problems in the cardiovascular field needed to be urgently addressed due to its high incidence, high mortality and poor prognosis. Searching for the optimal risk assessment method is currently a priority effort in this field. Recent studies have identified inflammation as one of the important pathophysiological mechanisms in the development and progress of HF, the detection and evaluation of multiple inflammatory indicators may be an important method to predict the regression of HF, therefore, exploration of simple and easy-to-perform inflammatory predictors with the optimal comprehensive performance is becoming a focus of attention.

Objective

To explore the predictive value of (neutrophil + monocyte) /lymphocyte ratio (NMLR) in peripheral blood on the in-hospital mortality of HF patients.

Methods

A total of 583 patients with HF admitted to Puyang Oilfield General Hospital from January 2020 to September 2022 were collected and divided into the survival group (n=564) and the death group (n=19) according to the occurrence of all-cause death during hospitalization. The baseline data was collected including demographic characteristic, complications, primary disease and laboratory test results; multivariate Cox analysis was used to explore the influencing factors of in-hospital mortality in HF patients; restrictive cubic spline (RCS) was used to determine the relationship between NMLR and in-hospital mortality in HF patients; receiver operating characteristic (ROC) curve was plotted to explore the predictive value of NMLR for in-hospital mortality of HF patients and calculate the optimal cut-off value; Kaplan-Meier method was used to plot the survival curves of patients with different NMLR values.

Results

The NMLR at admission in the death group〔8.36 (3.15, 9.55) 〕 was higher than that in the survival group〔5.00 (3.23, 8.72) 〕 (P<0.05), The results of multivariate Cox proportional hazards regression model showed that NMLR was the influencing factor of in-hospital mortality in HF patients〔HR=1.003, 95%CI (1.001, 1.005), P<0.05〕; the area under ROC curve for NMLR to predict in-hospital mortality of HF patients was 0.704〔95%CI (0.652, 0.757) 〕, with the optimal cut-off value of 7.93. The RCS showed a non-linear positive correlation between the NMLR value and the risk of in-hospital mortality in patients with HF (P<0.05). The in-hospital survival was lower in patients with NMLR≥7.93 than those with NMLR<7.93 (χ²=111.843, P<0.001) .

Conclusion

The elevated NMLR value at admission maybe an independent predictor of in-hospital mortality in HF patients.

Prevalence and Clinical Characteristics of Allergic Bronchopulmonary Aspergillosis in Patients with Bronchiectasis

CHEN Ai, SUN Lina, REN Jiaqi, CHANG Chun, CHEN Yahong, SUN Yongchang

2023, 26(30):  3797-3800.  DOI: 10.12114/j.issn.1007-9572.2023.0135

Asbtract ( )   HTML ( )   PDF (805KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Allergic bronchopulmonary aspergillosis (ABPA) is a lung disease caused by aspergillus sensitization, which is often misdiagnosed or missed diagnosis due to low prevalence, few case reports, and controversial diagnostic criteria, leading to inappropriate treatment and exacerbation of the disease. Previous studies have shown that ABPA is one of the etiologies of bronchiectasis, but its prevalence and clinical characteristics still remain to be studied.

Objective

To analyze the prevalence and clinical characteristics of ABPA in patients with bronchiectasis.

Methods

Outpatients or inpatients diagnosed with bronchiectasis and received examinations for peripheral blood eosinophilcount, serum total IgE and aspergillus-specific IgE at Peking University Third Hospital from January 2012 to September 2021 were retrospectively selected. The data including gender, age, smoking history, asthma/wheezing symptoma, laboratory indicators (peripheral blood eosinophil count, serum total IgE, aspergillus-specific IgE and IgG), chest CT (types of bronchiectasis, number oflobes involved), and pulmonary function indexes〔the first forced expiratory volume as a percentage of the predicted value (FEV₁%pred), ratio of the first forced expiratory volume and forced vital capacity in percentage (FEV₁/FVC) 〕was collected. The Smith score and the Bhalla score was used to evaluate the extent and the severity of bronchiectasis lesions, respectively. The included patients were divided into the ABPA group (n=10) and non-ABPA group (n=149) according to the combination of ABPA and analyzed for the cases with total serum IgE>60 U/mL, total serum IgE>500 U/mL, total serum IgE>1 000 U/mL, aspergillus-specific IgE>0.35 U/mL, and peripheral blood eosinophil count >0.5×10⁹/L.

Results

In 159 patients with bronchiectasis, 10 cases met the diagnostic criteria of ABPA (6.29%, 10/159) with elevated aspergillus-specific IgE level (>0.35 U/mL), including 9 cases with aspergillus-specific IgE>1 000 U/mL and 1 case with aspergillus-specific IgE<1 000 U/mL but fulfilled 3 other conditions (peripheral blood eosinophil count>0.5×10⁹/L, radiological bronchiectasis, positive serum aspergillus-specific IgG), of whom 7 cases had episodic wheezingsymptom and 9 cases with absolute peripheral blood eosinophil count>0.5×10⁹/L. Aspergillus-specific IgG was detected in 5 of the 10 cases with ABPA, 4 of whom were positive. Chest CT findings showed central bronchiectasis and peripheral bronchiectasis in 6 and 4 of the 10 cases with ABPA, and cystic bronchiectasis were shown in all 10 cases. Compared with the non-ABPA group, the ABPA group showed a higher number of lung lobesinvolved, Smith score and Bhalla score (P<0.05) .

Conclusion

Some casesmet the diagnostic criteria of ABPA among the patients diagnosed with bronchiectasis in the center, suggesting that total IgE and aspergillus-specific IgE should be detected in patients with central or severe bronchiectasis and increased peripheral blood eosinophils for the early diagnosis of ABPA.

Correlation between Aspartate Aminotransferase/Alanine Aminotransferase and Prognosis of Hemophagocytic Lymphohistiocytosis in Children

SHI Xiaoqi, LUO Nandu, HUANG Jiaojiao, DU Zuochen, HUANG Pei, CAO Xiuli, CHEN Yan, HE Zhixu

2023, 26(30):  3801-3808.  DOI: 10.12114/j.issn.1007-9572.2022.0879

Asbtract ( )   HTML ( )   PDF (865KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Aspartate aminotransferase (AST) /alanine aminotransferase (ALT) is a novel indicator to evaluate the prognosis of acute critical illness in recent years. At present, AST/ALT has only been reported to evaluate the prognosis of hemophagocytic lymphohistiocytosis (HLH) in adults, while HLH in children has not been studied.

Objective

To explore the relationship between AST/ALT and clinical characteristics and its prognostic significance in children with HLH, so as to provide a theoretical basis for early clinical recognition and diagnosis of HLH in children.

Methods

A total of 128 hospitalized children diagnosed with HLH in the Affiliated Hospital of Zunyi Medical University from January 2013 to May 2022 were selected as the research objects, and the baseline data of children were collected through the electronic medical record system. The children were divided into the T1 group (AST/ALT≤1.57, n=43), T2 group (1.57<AST/ALT<3.22, n=42), and T3 group (AST/ALT≥3.22, n=43) according to the AST/ALT quantiles, and followed up by outpatient review and telephone follow-up once every 6 months from the time of discharge to 2022-06-01, with the termination event of death or loss of follow-up. Spearman rank correlation analysis was used to explore the correlation between AST/ALT and laboratory test results. The receiver operating characteristic (ROC) curve of laboratory indicators for predicting death in children with HLHwas plotted, the area under ROC curve (AUC) and optimal cut-off value were calculated. Kaplan-Meier method was used to plot survival curves to analyze the effect of different AST/ALT groupings on overall survival, and Log-rank test was used for comparison. Cox proportional risk model was used to explore the influencing factors of death in children with HLH.

Results

There were statistically significant differences in gender, PICU admission, treatment methods, incidence of respiratory failure and shock among the 3 groups (P<0.05). Lactate dehydrogenase, creatine kinase isoenzyme, serum ferritin and activated partial thromboplastin time in the T3 group were higher than those in the T1 and T2 groups, while the levels of albumin and fibrinogen in the T3 group were lower than those in the T1 and T2 groups (P<0.05). Na⁺ level in the T2 and T3 groups was lower than that in the T1 group, while C-reactive protein level was higher than that in the T1 group (P<0.05). Correlation analysis showed that AST/ALT was positively correlated with absolute neutrophil count (r_s=0.182, P=0.040), C-reactive protein (r_s=0.419, P<0.001), total bilirubin (r_s=0.182, P=0.040), creatine kinase isoenzyme (r_s=0.310, P<0.001), lactate dehydrogenase (r_s=0.474, P<0.001), activated partial thromboplastin time (r_s=0.316, P<0.001), serum ferritin (r_s=0.311, P<0.001), and negatively correlated with albumin (r_s=-0.352, P<0.001), fibrinogen (r_s=-0.179, P=0.043), Ca²⁺ (r_s=-0.259, P=0.003), Na⁺ (r_s=-0.244, P=0.006). ROC curve results showed that the AUCs of C-reactive protein, lactate dehydrogenase, activated partial thromboplastin time, serum ferritin and fibrinogen were 0.560〔95%CI (0.451, 0.669) 〕, 0.666〔95%CI (0.560, 0.772) 〕, 0.605〔95%CI (0.499, 0.710) 〕, 0.724〔95%CI (0.626, 0.822) 〕, 0.648〔95%CI (0.551, 0.745) 〕 and 0.715〔95%CI (0.624, 0.807) 〕, respectively, with the optimal cutoff values of 82.08 mg/L, 40.5 U/L, 927.5 U/L, 53.95 s, 1 897 μg/L, and 1.45 g/L, respectively. The mortality rate in the T1, T2 and T3 groups was 14.0% (6/43), 33.3% (14/42) and 44.2% (19/43), respectively, with statistically significant differences (χ²=9.518, P=0.009). Multivariate Cox proportional hazard regression analysis showed that shock〔HR=4.24, 95%CI (2.09, 8.61), P<0.001〕, activated partial thromboplastin time ≥53.95 s〔HR=2.44, 95%CI (1.24, 4.81), P=0.010〕and serum ferritin ≥1 897 μg/L〔HR=3.05, 95%CI (1.02, 9.09), P=0.046〕were the risk factors for death in children.

Conclusion

HLH patients in children with higher AST/ALT have higher incidence of poor prognosis, shorter overall survival, and worse prognosis.

Cost-effectiveness Analysis of GnRH Antagonist Protocol and Short-acting GnRH Agonist Long Protocol in Fresh Embryo Transfer Based on Propensity Score Matching

HUANG Taishuai, CHI Yan, HE Ping, HUANG Guolan, ZUO Yanli

2023, 26(30):  3809-3814.  DOI: 10.12114/j.issn.1007-9572.2022.0871

Asbtract ( )   HTML ( )   PDF (837KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

In the field of assisted reproductive technology, medical cost of patients is increasingly considered as an important reference for making treatment protocols, while domestic health economics researches are rarely reported on the cost-effectiveness of gonadotropin-releasing hormone antagonist (GnRH-ant) protocol and short-acting GnRH agonist (GnRH-a) long protocol in fresh embryo transfer.

Objective

To analyse the cost-effectiveness of the clinical outcomes of GnRH-ant and GnRH-a protocols in fresh embryo transfer based on propensity score matching (PSM) .

Methods

A total of 1 971 patients treated with 2 117 cycles of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) at the Reproductive Medicine and Genetics Center of the People's Hospital of Guangxi Zhuang Autonomous Region from 2016 to 2018 were selected and divided 422 patients with 432 cycles in the GnRH-ant group and 1 549 patients with 1 685 cycles in the GnRH-a group according to the protocols of controlled ovarian hyperstimulation (COH). Baseline data 〔including female age, type and duration of infertility, BMI, age at menarche, number of pregnancies, follicle stimulating hormone (FSH), basal estradiol (E₂), basal luteinizing hormone (LH), basal progesterone, antral follicle count (AFC), etc.〕, therapeutic indicators 〔including COH protocols, gonadotropin (Gn) durarion, total Gn dosage, E₂, LH, progesterone level and endometrial thickness on the trigger day, number of retrieved and mature oocytes, fertilization methods, number of transferable embryos, high-quality embryos and transferred embryos, etc.〕 and the clinical outcomes〔including unpregnancy, miscarriage, ectopic gestation, live birth (LB) 〕 were collected from the electronic medical record system and the 1∶1 PSM was performed using R 4.1.1 software with caliper value of 0.2. Cost-effectiveness analysis was performed on the two groups after PSM, sensitivity analysis was applied to verify the robustness of the study findings.

Results

There were significant differences in female age, BMI, basal FSH, LH, and AFC between the two groups before PSM (P<0.05). A total of 390 cycles were included in each group after PSM, and there was no significant difference in female age, BMI, basal FSH, LH, and AFC between the two groups after PSM (P>0.05). Therapeutic indicators including Gn duration, Gn dosage, E₂ and endometrial thickness on the trigger day, number of retrieved and mature oocytes were lower in the GnRH-ant group than GnRH-a group, while LH level on the trigger day was higher in the GnRH-ant than the GnRH-a group (P<0.05) after PSM. Clinical outcomes including clinical pregnancy rate (43.08% vs. 54.62%, P=0.001), implantation rate (29.15% vs. 37.01%, P=0.001), and LB rate (33.59% vs. 44.10%, P=0.003) were significantly lower in the GnRH-ant group than GnRH-a group after PSM. The cost of ovulation induction drug per cycle and total cost per cycle were lower in the GnRH-ant group than the GnRH-a group after PSM (P<0.05). Using LB rate as the endpoint indicator, cost-effectiveness analysis showed that the cost per LB was 66 397.92 and 54 226.33 yuan in the GnRH-ant group and GnRH-a group, respectively. The incremental cost-effectiveness ratio was 15 325.88 yuan, less than 1 time of per capita GDP in China in 2018 (64 644 yuan). The results of sensitivity analysis were consistent with the results of the basic analysis.

Conclusion

In fresh embryo transfer cycles, the clinical outcomes and economy performances of GnRH-a protocol are superior to GnRH-ant protocol.

Evidence-based Medicine

Efficacy and Safety of Programmed Death-1/Programmed Death-1 Ligand Inhibitors in the Treatment of Renal Cell Cancer: a Meta-analysis

ZHANG Dongli, SHEN Chong, ZHANG Weichuan, CHEN Haibin, ZHAO Jianjun

2023, 26(30):  3815-3822.  DOI: 10.12114/j.issn.1007-9572.2023.0180

Asbtract ( )   HTML ( )   PDF (1557KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Renal cell carcinoma (RCC) is characterized by insidious onset, lack of early typical clinical manifestations, metastasis or advanced stage at diagnosis in most patients and poor efficacy of radical nephrectomy. In recent years, with the broadly application of targeted therapies in tumors, the postoperative recurrence and mortality rates have been greatly reduced. However, there is a lack of evidence for the efficacy and safety of clinical treatment due to the existence of certain adverse effects and complications.

Objective

To systematically review the efficacy and safety of programmed death-1 (PD-1) /programmed death-1 ligand (PD-L1) inhibitors in the treatment of RCC.

Methods

CNKI, Wanfang Data, VIP, PubMed, Web of Science, Embase, Cochrane Library, Clinical Trials and other English databases were searched by computer and manually for the randomized controlled trials of PD-1/PD-L1 inhibitors for RCC from the inception to 2022-09-30. Two researchers independently extracted and collated the data, evaluated the quality of the included literature according to Cochrane 5.3 manual criteria, and performed meta-analysis using RevMan 5.4 software.

Results

A total of 11 papers were finally included, involving 7 895 study subjects with 3 936 cases in the trial group and 3 959 cases in the control group. Meta-analysis results showed that the overall survival (OS) and progression-free survival (PFS) were better in the trial group than in the control group〔HR=0.87, 95%CI (0.84, 0.90), P<0.000 01; HR=0.85, 95%CI (0.78, 0.92), P<0.000 1〕; the objective response rate (ORR), partial response rate (PR), complete response rate (CR), and disease-control rate (DCR) were higher in the trial group than in the control group〔RR=1.72, 95%CI (1.39, 2.12), P<0.000 01; RR=1.56, 95%CI (1.20, 2.01), P=0.000 7; RR=3.05, 95%CI (2.39, 3.09), P<0.000 01; RR=1.12, 95%CI (1.05, 1.20), P=0.000 5〕; the rate of stable disease (SD) was lower in the trial group than in the control group〔RR=0.66, 95%CI (0.62, 0.72), P<0.000 01〕. The differences were not statistically significant when comparing the rate of PD, total rate of adverse events (AEs), rates of grade Ⅰ-Ⅱ adverse events and grade Ⅲ-Ⅴ adverse events between the trial and control groups〔RR=0.73, 95%CI (0.53, 0.99), P=0.05; RR=1.01, 95%CI (0.89, 1.04), P=0.60; RR=1.02, 95%CI (0.88, 1.17), P=0.82; RR=1.02, 95%CI (0.88, 1.19), P=0.80〕. Egger's tests resulted in P>0.05, indicating no significant publication bias among studies.

Conclusion

PD-1/PD-L1 inhibitors for RCC can significantly improve and enhance OS, PFS, ORR, CR, PR and DCR in patients without increasing the incidence of adverse effects in terms of safety, thus confirming the superiority of PD-1/PD-L1 inhibitors for RCC in terms of clinical efficacy and safety.

Efficacy of Western Medicine, Chinese Patent Medicine and Their Combination on Post-stroke Insomnia: a Network Meta-analysis

ZHU Lin, GUO Yankui, GAO Chen, CHEN Xuezhi, WANG Fashuai

2023, 26(30):  3823-3832.  DOI: 10.12114/j.issn.1007-9572.2023.0209

Asbtract ( )   HTML ( )   PDF (978KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Post-stroke insomnia is one of the most common post-stroke complications, which seriously damages the quality of life and delays the process of rehabilitation. Clinical studies have shown that Western medicine alone, Chinese patent medicine alone and the combination of both are effective in the treatment of post-stroke insomnia. However, at present, there is still no network Meta-analysis to compare the efficacy of the three treatments.

Objective

To evaluate the efficacy of Western medicine alone, Chinese patent medicine alone and their combination in treating post-stroke insomnia by network Meta-analysis.

Methods

Chinese databases such as CNKI, CBM, Wanfang Data, VIP and English databases such as PubMed, Embase and Cochrane Library were researched by computer for randomized controlled trials involving Western medicine alone, Chinese patent medicine alone and the combination of both from inception to December 2022. Two researchers independently performed the evaluation of the risk of bias and quality assessment for the included studies. RevMan5.4、StataMP 14 and R 4.2.3 were used for statistical analysis.

Results

A total of 41 papers (41 two-arm RCT studies) with 3 916 patients were enrolled, including 1 959 cases in the treatment group and 1 957 cases in the control group. Network Meta-analysis results showed that in terms of improving efficiency, combination treatment was superior to Chinese patent medicine alone and Western medicine alone (P<0.05) ; in short-term treatment (duration≤4 weeks), the effective rate of combined treatment and Chinese patent medicine alone was better than that of Western medicine alone (P<0.05) ; in long-term treatment (duration ≥8 weeks), the effective rate of combined treatment was better than that of Western medicine or proprietary Chinese medicine alone (P<0.05). In terms of improving PSQI score, combination treatment was superior to Chinese patent medicine alone and Western medicine alone (P<0.05) ; in terms of safety, the use of Chinese patent medicine can reduce the occurrence of adverse events. The ranking of efficiency improvement was (with rank probability values in parentheses) : combination treatment (0.999) >Chinese patent medicine alone (0.889) >Western medicine alone (0.890). The ranking of short-term treatment efficiency was combination treatment (0.535) >Chinese patent medicine alone (0.526) >Western medicine alone (0.991). The ranking of long-term treatment efficiency was combination treatment (0.989) >Chinese patent medicine alone (0.529) >Western medicine alone (0.537). The ranking of PSQI score improvement was combination treatment (0.982) >Chinese patent medicine alone (0.975) >Western medicine alone (0.992) .

Conclusion

All three treatments for post-stroke insomnia have shown good efficacy and safety in terms of improving clinical efficiency and PSQI scores, and the most significant effect was shown in the combination treatment. However, high-quality, large sample studies are needed to verify the results.

Review & Perspectives

Research Progress of Mitochondrial Transfer in Post-stroke Cognitive Impairment

XIAO Yuqian, BAI Yanjie, WANG Yan, CHEN Shuying, CHEN Limin, SUN Kexin, WAN Jun

2023, 26(30):  3833-3840.  DOI: 10.12114/j.issn.1007-9572.2023.0162

Asbtract ( )   HTML ( )   PDF (866KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Stroke often leads to persistent post-stroke cognitive impairment (PSCI), which mainly manifests as impairment in learning and memory. The pathogenesis remains unclear as present, but it is closely related to mitochondrial dysfunction, and healthy mitochondria are essential for neuronal survival. Recent studies have shown that intercellular mitochondrial transfer can be linked to stroke through increasing neuronal viability, enhancing mitochondrial metabolism, and modulating neuroinflammation, thereby improving cognitive impairment. This review overviews the mechanisms of mitochondrial transfer and the key role of intercellular mitochondrial transfer in PSCI, and discusses that mitochondrial transplantation may serve as a novel therapeutic intervention for PSCI, providing references for its clinical management.

Research Progress of Structure, Function and Mechanism of Action of Mitofusin 2 in Liver Diseases

YUAN Xiwei, NAN Yuemin

2023, 26(30):  3841-3846.  DOI: 10.12114/j.issn.1007-9572.2023.0146

Asbtract ( )   HTML ( )   PDF (812KB) ( )  

References | Related Articles | Metrics

The liver is the largest metabolic organ in the human body, and impaired liver function can lead to a variety of acute and chronic liver diseases, which can affect the quality of life in mild cases or be life-threatening in severe cases. Therefore, it is important to explore accurate and effective molecular diagnostic markers and therapeutic targets. Mitofusin 2 (Mfn2) is a transmembrane motor protein on the outer membrane of mitochondria, and plays an important role not only in mitochondrial fusion regulation, but also in cell energy metabolism, cell apoptosis, cell proliferation, mitochondrial endoplasmic reticulum (ER) connections, ER stress and mitochondrial autophagy, etc. It has been found that abnormal expression or function loss of Mfn2 can lead to abnormal mitochondrial function, which in turn leads to a variety of liver diseases. In this paper, a systematic review of the structure and function of Mfn2 and its mechanisms of action in liver diseases was conducted and found that Mfn2 can be involved in the development of chronic liver diseases through multiple pathways, and improve liver function through modulating Mfn2 overexpression to further slow down and reverse disease progression. This paper aims to provide a scientific reference for basic research of Mfn2 and liver diseases, as well as its clinical application.