Table of Content

20 February 2024, Volume 27 Issue 06

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Editorial

General Practice in Medicine—Reflections of Lancet's Iconic Texts at Its Milestone of 200 Anniversary (5) : John Fry's General Practice International Comparative Study

YANG Hui

2024, 27(06):  0-H.  DOI: 10.12114/j.issn.1007-9572.2024.A0006

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Review & Perspectives

Research Progress in Epidemiology and Risk Factors of Primary Liver Cancer

CHEN Qianqian, RUI Fajuan, NI Wenjing, LI Jie

2024, 27(06):  637-642.  DOI: 10.12114/j.issn.1007-9572.2023.0479

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Primary liver cancer is one of the common cancers in the world and with extremely high morbidity and mortality. This paper details the current epidemiology of primary liver cancer, population attributable fractions and associated risk factors in China. In this paper, we found that hepatitis B virus and hepatitis C virus are still the main risk factors for the development of primary liver cancer by searching the databases such as PubMed, Web of Science, and CNKI. With hepatitis B virus vaccination and antiviral treatment, the incidence of primary liver cancer in China has slightly decreased, but the incidence of primary liver cancer caused by metabolic factors such as diabetes, obesity and non-alcoholic fatty liver disease is gradually increasing; smoking and alcohol consumption are also important risk factors. This article summarizes the epidemiological characteristics and risk factors of primary liver cancer, which can provide practical evidence-based medicine evidence for the development of preventive and control measures for primary liver cancer.

Review & Perspectives

Research Progress of Sarcopenic Obesity in Cancer

PENG Lei, ZHU Kexiang

2024, 27(06):  643-649.  DOI: 10.12114/j.issn.1007-9572.2023.0264

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As the number of obese and elderly population increases worldwide, sarcopenic obesity is becoming associated with a higher risk of adverse events and outcomes in multiple clinical situations, including cancer. However, there is a lack of unified definition and diagnostic criteria for sarcopenic obesity, and the interaction between sarcopenic obesity and cancer needs to be further clarified. This paper systematically and comprehensively summarizes the relevant definitions and diagnostic methods of sarcopenic obesity, discusses its clinical impact on cancer patients in detail, including the impact on patients undergoing surgery and chemotherapy, and briefly describes the main prevention and treatment strategies. This paper reviews literature and concludes that the incidence of sarcopenic obesity is high in cancer patients, but its definition and diagnostic criteria are still controversial. Sarcopenic obesity is an independent predictor of cancer prognosis with important clinical application value.

Guidelines Interpretation

Interpretation of the 2022 ICCE/AME Position Statement for Clinical Practice in Pituitary Prolactinoma: Update on Clinical Characteristics and Points of Diagnosis and Treatment of Pituitary Prolactinoma

TAN Huiwen, LI Danting, YU Yerong

2024, 27(06):  650-655.  DOI: 10.12114/j.issn.1007-9572.2023.0022

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Pituitary prolactinoma is a neuroendocrine disease caused by excessive pituitary prolactin-cell adenoma synthesis and prolactin secretion. The standardized diagnosis and treatment of pituitary prolactinoma in of great significance for recovering and maintaining pituitary function and improving life quality of the patients. In January 2022, the International Chapter of Clinical Endocrinology (ICCE) and the Italian Association of Clinical Endocrinologists (AME) published a position statement on pituitary prolactinoma in the European Journal of Endocrinology: 2022 ICCE/AME Position Statement for Clinical Practice in Pituitary Prolactinoma (abbreviated as 2022 ICCE/AME position statement) . Based on the latest medical evidence, 2022 ICCE/AME position statement conducts a systematic review, analysis and recommendations on the clinical diagnosis and treatment of pituitary prolactinoma. This article provides an update on the diagnosis and treatment of pituitary prolactinoma, special populations, dopamine agonist resistance, and invasive prolactinoma in the 2022 ICCE/AME position statement, which is hoped to be helpful to the awareness of pituitary prolactinoma among general practitioners and endocrinologists, and provide a reference for the clinical practice of standardized diagnosis and treatment.

Original Research

Maternal Quality of Life and Influencing Factors in Rural China

SUN Yuxin, ZHAN Haoran, AYIXIAMU· Keyimu, XU Tingting

2024, 27(06):  656-662.  DOI: 10.12114/j.issn.1007-9572.2023.0480

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Background

The development of maternal and child health requires reducing urban-rural, regional and group disparities in the health of women and children. Focusing on the quality of life of maternal women in rural areas and other low-income areas is of great significance to improve the inequalities in maternal and child health.

Objective

To analyze the current situation of maternal quality of life during pregnancy and its influencing factors in rural China.

Methods

From September 2018 to September 2019, a total of 3 329 pregnant women were selected from 6 county-level medical institutions in Shanxi Province, Sichuan Province and Yunnan Province (Zhaoyang District People's Hospital, Yiliang County People's Hospital, Pingchang County Maternal and Child Health Care Hospital, Yingshan County Maternal and Child Health Care Hospital, Ziyang County Maternal and Child Health Care Hospital, and Hanyin County Maternal and Child Health Care Hospital) as the research objects to collect basic information of pregnant women. WHOQOL-BREF scale was used to investigate the quality of life of pregnant women. Multiple linear regression analysis was used to explore the influencing factors of each dimension of the quality of life score.

Results

A total of 3 294 questionnaires were included, with a valid questionnaire rate of 98.94%. The average WHOQOL-BREF score of pregnant women was (81.99±11.01) points, and the social relation score was the highest among the 4 dimensions [ (69.13±12.46) points] , followed by the psychological dimension score [ (66.99±12.59) points] , physiological dimension score [ (65.40±12.62) points] , environmental dimension score [ (65.02±12.11) points] . Stratified comparison results showed that there were statistically significant differences in the scores of physiological dimension, psychological dimension, social relation dimension and environmental dimension among pregnant women of different ages, total annual income levels, places of residence, education levels and occupations (P<0.05) . The difference was statistically significant in psychological dimension score when comparing pregnant women with different preconception BMI (P<0.05) . There were significant differences in the scores of psychological dimension and environmental dimension of pregnant women with weight gain during different gestation periods (P<0.05) . The scores of psychological dimension, social relation dimension and environmental dimension of pregnant women with different medical insurance types were compared, and the differences were statistically significant (P<0.05) . The score of environmental dimension of parturients was significantly lower than that of parturients (P<0.05) . The scores of physiological dimension, psychological dimension and environmental dimension of pregnant women with exercise habit were higher than those of pregnant women without exercise habit, and the difference was statistically significant (P<0.05) . The results of multiple linear regression analysis showed that age, exercise habit, education level and occupation were the influencing factors of physiological dimension score (P<0.05) . Age, pre-pregnancy BMI, family history, exercise habits, education level and medical insurance type were the influencing factors of psychological dimension score (P<0.05) . Age and exercise habit were the influencing factors of social relation dimension score (P<0.05) . Family history, weight gain during pregnancy, exercise habits, residence type, occupation, total annual income level and medical insurance type were the influencing factors of environmental dimension score (P<0.05) .

Conclusion

There is still much room for improvement in the quality of life of pregnant women in rural areas of China. In addition to individual factors such as age, parity, social factors such as place of residence and health insurance coverage are also significant influencing factors, improvement from the social perspective remains a priority for maternal and child health care in the future.

The Impact of Widowhood on the Mental Health of Older Adults in China: Analysis Based on the Perspective of Mental Frailty Index

LI Yang, WANG Zhen, ZENG Zhi

2024, 27(06):  663-669.  DOI: 10.12114/j.issn.1007-9572.2023.0038

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Background

Population aging in China is deepening, and the widowed rate of the elderly is also on the rise. Widower is one of the most stressful events in the human life course, and its impact also affects the mental health and economic level of widower. In many studies on the impact of widower on the mental health of the elderly at home and abroad, the proxy variables used are traditional indicators, such as subjective well-being, loneliness, depression level, and some studies do not consider the endogeneity between widowhood and health status.

Objective

To evaluate the impact of widowhood on the mental health of older adults in China, and provide a basis and reference for formulating the mental health intervention program for older adults in China.

Methods

Using the 2018 China Health and Retirement Longitudinal Study (CHARLS) as the data source, 4 694 older adults aged 60 years and above were selected as study subjects and divided into the widowed group (n=644) and non-widowed group (n=4 050) . The mental frailty index was used as a perspective for evaluating the mental health status of older adults. Using propensity score matching (PSM) model, the propensity score was calculated by using Logit regression analysis, the robustness was tested by using standard deviation variation, common support bar graph and nuclear density distribution, the impact of widowhood on the physical and mental health of older adults was analyzed by using K-nearest neighbor matching, radius matching and kernel matching, and the heterogeneity was tested based on gender, household type and age.

Results

Compared to the non-widowed group, the mental health of older adults in the widowed group was impaired (P<0.05) . Logit regression model results showed that female (OR=2.274, 95%CI=1.917-2.698) , age (OR=0.975, 95%CI=0.972-0.978) , secondary education level (OR=0.618, 95%CI=0.505-0.756) and monthly family consumption (OR=1.000, 95%CI=1.000-1.000) were correlated with widowhood (P<0.05) . The robustness test results after matching were better. The results of PSM showed that widowhood significantly increased the mental frailty index level (ATT ranged from 0.054 to 0.055, P<0.05) . The results of heterogeneity test showed that there were significant differences between urban and rural areas and among different age groups in the impact of widowhood on the mental frailty index of older adults, but there was no significant difference between male and female in the impact of widowhood on the mental frailty index of older adults. Among them, the impact of widowhood on the older adults in rural areas was more significant (ATT ranged from 0.072 to 0.075, P<0.05) , but the impact on older adults in urban areas was not significant; the impact on older adults in the low age group and high age group was more significant (ATT ranged from 0.061 to 0.081, P<0.05; 0.067-0.078, P<0.05) , but the impact on older adults in the middle age group was not significant.

Conclusion

Widowhood has a negative impact on the mental health of the older adults. The impact varies among different older adults. The widowed older adults in rural areas, just entering old age and in their later years need attention and psychosocial support.

Prevalence of Dyslipidemia in Pregnancy and Early Predictive Value of Blood Lipid Levels

YUAN Xianxian, LI Jing, WANG Jia, ZHANG Kexin, YANG Ruihua, ZHENG Wei, LI Guanghui

2024, 27(06):  670-678.  DOI: 10.12114/j.issn.1007-9572.2023.0349

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Background

Elevated dyslipidemia during pregnancy can adversely affect maternal and child health. It not only increases the risk of preeclampsia, gestational diabetes mellitus (GDM) , hypertriglyceridemic pancreatitis, late abortion, premature delivery and macrosomia, but also significantly increases the risk of postnatal cardiovascular disease.

Objective

To analyze the distributional characteristics of dyslipidemia in the first, second and third trimesters of pregnancy and the predictive value of early lipid levels for dyslipidemia in the second and third trimesters of pregnancy.

Methods

This was a single-center retrospective study, which included singleton pregnant women who were enrolled in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2018 to June 2019 for obstetrics checkups until delivery. Clinical data and lipid data [total cholesterol (TC) , triacylglycerol (TG) , low-density lipoprotein cholesterol (LDL-C) , and high-density lipoprotein cholesterol (HDL-C) ] were collected in the first, second and third trimesters of pregnancy. The reference range of lipids in department of obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University was used as the diagnostic standard for dyslipidemia, including high total cholesterolemia, high triacylglycerolemia, low HDL-cholesterolemia and high LDL-cholesterolemia. The correlation between lipid levels in the first trimester of pregnancy and dyslipidemia in the second and third trimesters of pregnancy was analyzed by using binary Logistic regression, and the receiver operating characteristics (ROC) curves of the subjects were plotted to obtain the area under ROC curve (AUC) , to evaluate the predictive value of the lipid levels in the first trimester of pregnancy for dyslipidemia in the second and third trimesters of pregnancy, and to determine the optimal cut-off value according to the sensitivity and specificity.

Results

A total of 8 511 singleton pregnant women were included in the study, with an average age of (31.7±3.9) years and an average pre-pregnancy BMI of (21.7±3.2) kg/m². Among them, 988 (11.6%) were of low pre-pregnancy body mass, 5 568 (65.4%) were of normal pre-pregnancy body mass, 1 271 (14.9%) were overweight, 366 (4.3%) were obese, 1 415 (16.7%) were with GDM, and 650 (7.6%) were with hypertensive disorders of pregnancy (HDP) . The levels of TC, TG and LDL-C in the second and third trimesters of pregnancy were higher than those in the first trimester of pregnancy (P<0.05) . The level of HDL-C in the third trimester of pregnancy was higher than that in the first trimester of pregnancy, but lower than that in the second trimester of pregnancy (P<0.05) . The prevalence of dyslipidemia in the first trimester of pregnancy was 23.4% (1 990/8 511) , and the prevalence of dyslipidemia in the second and third trimesters of pregnancy was lower than that in the first trimester of pregnancy (P<0.05) . The prevalence of dyslipidemia in overweight and obese pregnant women in the first trimester of pregnancy was higher than that in pregnant women with normal pre-pregnancy body mass, but there was no statistical difference in the prevalence of dyslipidemia in the third trimester of pregnancy (P>0.05) . The prevalence of dyslipidemia in first and second trimesters of pregnancy in the GDM group was higher than that in the non-GDM group, and the prevalence of dyslipidemia in first, second and third trimesters of pregnancy in HDP group was higher than the non-HDP group (P<0.05) . After excluding pregnancy comorbidities and complications that may affect blood lipids, the optimal cut-off values for predicting dyslipidemia in the second trimester of pregnancy were TC of 4.485 mmol/L (AUC=0.854) , TG of 1.325 mmo/L (AUC=0.864) , HDL-C of 1.275 mmol/L (AUC=0.908) , and LDL-C of 2.265 mmol/L (AUC=0.823) , respectively; the optimal cut-off values for predicting dyslipidemia in the third trimester of pregnancy were TC of 4.485 mmol/L (AUC=0.809) , TG of 1.145 mmol/L (AUC=0.833) , HDL-C of 1.285 mmol/L (AUC=0.851) , LDL-C of 2.195 mmol/L (AUC=0.766) .

Conclusion

The prevalence of dyslipidemia did not increase during pregnancy. There were significant differences in the prevalence of dyslipidemia during pregnancy among pregnant women with different pre-pregnancy BMI, between GDM and non-GDM pregnant women, between HDP and non-HDP pregnant women, respectively. The blood lipid level in the first trimester was helpful to predict the occurrence of dyslipidemia in the second and third trimesters of pregnancy.

Genetic Etiology and Risk Factors for Mortality in Primary Dilated Cardiomyopathy in Children

ZHENG Kui, LIU Lu, WANG Yongli, LI Hui, WANG Xuan, LI Bo, HAO Jingxia, ZHANG Yingqian

2024, 27(06):  679-684.  DOI: 10.12114/j.issn.1007-9572.2023.0338

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Background

Dilated cardiomyopathy (DCM) is a common cause of sudden cardiac death and heart failure in children, its different etiologies are significantly associated with the prognosis of children with DCM. However, there is a lack of accurate etiologic diagnosis and effective risk stratification programs. Primary DCM has the highest prevalence and relatively poor prognosis, especially in children with genetic factors. Therefore, the analysis of mortality risk factors based on genetic background would be beneficial for the accurate prognosis and risk stratification of children with DCM.

Objective

To explore the proportion of genetic etiology, genetic characteristics and factors related to poor prognosis of primary DCM in children.

Methods

The clinical data and genetic testing results of 42 children with primary DCM who were hospitalized in Hebei Children's Hospital from July 2018 to December 2022 and completed genetic testing were retrospectively collected, and the included children were regularly followed up in the cardiology outpatient department of Hebei Children's Hospital after discharge. With the time of death or 2022-12-31 as the end point of follow-up, the children were divided into the death group (9 cases) and survival group (33 cases) according to the follow-up outcomes. Survival curves of the children were plotted using the Kaplan-Meier method, and comparisons between groups were performed using the Log-rank test. Multivariate COX proportional risk model was used to analyze the risk factors for death.

Results

The median age of first diagnosis was 12 (7, 96) months, and the median follow-up time was 24 (9, 36) months. The median follow-up time was 8 (0, 11) months in the death group and 30 (12, 39) months in the survival group, the difference was statistically significant (Z=-2.19, P<0.05) . The proportion of male, heart function grade Ⅲ/Ⅳ and gene mutation positive in the death group was higher than that in the survival group, and the left ventricular short axis shortening rate (LVFS) was lower than that in the survival group (P<0.05) . The positive rate of gene mutation was 38.1% (16/42) , of which 25.0% (4/16) were spontaneous mutations and 61.9% (26/42) were negative mutations. All the 9 children in the death group died within 1 year after diagnosis, including 8 patients with positive gene mutation (50.0%, 8/16) and 1 patient with negative gene mutation (3.8%, 1/26) , with statistically significant differences between the two groups (P<0.05) . The heterozygous variation of CSRP3 (c.190C>T) in the dead children with negative gene mutation was classified as unclear clinical significance. The Kaplan-Meier survival curve of the children was plotted, and the Log-rank test results showed that the survival rate of children with negative gene mutation was higher than that of children with positive gene mutation (χ²=18.1, P<0.001) . Multivariate COX proportional risk model analysis showed that gene mutation [HR=23.91, 95%CI= (1.80-317.21) , P=0.016] and cardiac function grade Ⅲ/Ⅳ [HR=11.29, 95%CI (1.13-112.68) , P=0.039] were risk factors for death in children with DCM.

Conclusion

In this study, 38.1% of children with primary DCM were associated with genetic etiology. The first year after diagnosis is the high incidence of death of children with DCM, and the prognosis of children with positive gene mutation is worse. The presence of pathogenic gene mutation and the cardiac function grade of Ⅲ~Ⅳ at the first diagnosis are independent risk factors for death in children.

Evaluation of Estimating 24-hour Urinary Sodium Excretion from Spot Urine in Chinese Primary Hypertension Patients

SUN Xinghe, WANG Yang, KANG Junping, LIU Xiaohui

2024, 27(06):  685-691.  DOI: 10.12114/j.issn.1007-9572.2022.0765

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Background

It is important to estimate the sodium intake of primary hypertension patients through 24-hour urine sodium excretion, but the collection and testing processes are complicated. It is not clear whether the existing equation for estimating 24-hour urinary sodium excretion from spot urine sample is valid in Chinese primary hypertension patients.

Objective

To evaluate the validity of the Kawasaki, INTERSALT, and Tanaka equations using spot urine samples to estimate 24-hour urinary sodium excretion among Chinese primary hypertension patients.

Methods

This study retrospectively selected hospitalized primary hypertension patients from Department of Cardiology Peking University International Hospital from March 2018 to March 2021. General data were collected. The 24-hour urinary sodium extraction in the 24-hour urine sample was measured. The 24-hour urinary sodium extraction from spot urine sample was estimated. Paired t-test was used to measure the significance of difference between the 24-hour urine sodium excretion from spot urine samples predicted using Kawasaki, INTERSALT or Tanaka equation and measured 24-hour urinary sodium excretion from 24-hour urine collections, and the correlation and agreement between them were analyzed using the Spearman correlation coefficient and Bland–Altman plots, respectively. Relative deviation was calculated. The accuracy of the three equations were also evaluated in patients with different levels of salt intake, diabetes or proteinuria.

Results

One hundred and ninety-six patients were finally included for analysis. The average 24-hour urinary sodium excretion level was (165.04±78.53) mmol/d, which was equivalent to daily NaCl intake of (9.65±4.59) g/d. Female patients were older, had higher ratios of microalbuminuria and proteinuria, while lower BMI, diastolic blood pressure on admission, 24-hour average diastolic blood pressure compared with male patients (P<0.05) . Moreover, female patients were less likely to be smokers, and had lower spot urine sodium, as while as lower 24-hour urinary sodium excretion (P<0.05) . The 24-hour urinary sodium excretion estimated by Kawasaki equation was significantly higher than the measured value (t_paired=-8.008, P<0.001) , and the Bland-Altman plots showed that 94.90% spots were in 95%CI. The 24-hour urinary sodium excretion estimated by INTERSALT equation was significantly lower than the measured value (t_paired=4.167, P<0.001) . The Bland-Altman plots showed that 94.39% spots were in 95%CI. The 24-hour urinary sodium excretion estimated by Tanaka equation was higher than the measured value (t_paired=-0.547, P>0.05) without significant difference, and the Bland-Altman plots showed that 96.43% spots were in 95%CI. The relative deviation of Kawasaki, INTERSALT and Tanaka equations was -31.82%, 12.94 % and -1.90%, respectively. After dividing patients according to salt intake, the moderate correlation between predicted and actual values of each equation was no longer significant. There was no significant difference in the predictive accuracy of the equations between patients with and without diabetes or proteinuria.

Conclusion

The accuracy and consistency of the Kawasaki, INTERSALT and Tanaka equations in estimating 24-hour urinary sodium levels by spot urine in primary hypertension patients were poor. Tanaka's overall estimated value is the closest to the measured mean value. No comorbidity (such as diabetes, proteinuria) that might affect urinary sodium excretion was found to have a significant effect on the accuracy of the estimation equation.

Prognostic Analysis of IgA Nephropathy Patients with High Risk of CKD Progression Treated with Glucocorticoid: a Retrospective Study

GAO Ge, ZHANG Xinyue, FENG Yuhua, DOU Jingyu, WU Xueying, CHENG Genyang

2024, 27(06):  692-698.  DOI: 10.12114/j.issn.1007-9572.2023.0263

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Background

IgA nephropathy (IgAN) is a common primary glomerulonephritis worldwide, and the improvement of glucocorticoid on the renal prognosis of IgAN patients with high risk of CKD progression remains unclear.

Objective

To explore the effect of glucocorticoid therapy on the therapeutic response and renal prognosis of IgAN patients with high risk of CKD progression.

Methods

IgAN patients with high risk of CKD progression were recruited in the First Affiliated Hospital of Zhengzhou University from January 2017 to October 2021 as study subjects and divided into the glucocorticoid treatment group and supportive treatment group according to whether glucocorticoid therapy was performed. Propensity matching method (PSM) was used to screen patients for cases by 1∶1 matching according to gender, age, 24 h urine protein and eGFR, the clinicopathological data of patients, disease remission, adverse reactions within 1 year were recorded. The patients were followed up from the date of initiation of supportive therapy until October 31, 2022. The primary endpoint event was defined as progression to end-stage renal disease (ESRD) or receiving dialysis. The composite endpoint event was defined as sustained decline in eGFR of more than 30% from baseline, or progression to ESRD, or receiving dialysis or death. Kaplan-Meier method was used to plot survival curves and log-rank test was used to compare differences in the cumulative incidence of the primary/composite endpoint events between the two groups of patients. Cox proportional hazards regression analysis was used to analyze the possible influencing factors of renal prognosis in IgAN patients with high risk of CKD progression.

Results

A total of 236 patients with primary IgAN met the inclusion criteria. After 1∶1 matching, 97 cases in the glucocorticoid treatment group were successfully matched with 97 cases in the supportive therapy group with balanced baseline data. The complete remission rate and partial remission rate of patients in the glucocorticoid treatment group were higher than those in supportive treatment group (χ²=6.171, P=0.013; χ²=3.973, P=0.046) . The median follow-up time was 18.00 (9.75, 28.00) months. Kaplan-Meier survival curve analysis showed that the cumulative incidence of primary endpoint event in the glucocorticoid treatment group was lower than the supportive treatment group (χ²=4.495, P=0.034) and the cumulative survival rate of composite endpoint event in the glucocorticoid therapy group was lower than the supportive therapy group (χ²=4.419, P=0.036) . Among the 236 patients who met the inclusion criteria, there were 177 patients with moderate proteinuria. After 1∶1 matching of the 177 patients on glucocorticoid treatment and supportive treatment by sex, age, 24 h urine protein and eGFR using PSM, 76 cases in each group were successfully matched. Kaplan-Meier survival curve analysis showed that the cumulative incidence of primary endpoint event in the patients on glucocorticoid treatment with moderate proteinuria was lower than those on supportive treatment with moderate proteinuria (χ²=4.127, P=0.042) ; and the cumulative survival rate of composite endpoint event in the patients on glucocorticoid treatment with moderate proteinuria was lower than those on supportive treatment with moderate proteinuria (χ²=4.934, P=0.026) . Multivariate Cox proportional hazard regression analysis showed that hemoglobin (HR=0.982) , serum creatinine (HR=1.019) , eGFR (HR=1.020) and 24-hour urine protein (HR=1.205) were influencing factors of primary endpoints event in IgAN patients with high risk of CKD progression. The incidence of infection in the glucocorticoid treatment group was higher than the supportive treatment group (P<0.05) .

Conclusions

In IgAN patients with high risk of CKD progression, compared with simple supportive treatment, glucocorticoid treatment can significantly improve the renal remission rate and reduce the risk of renal function decline and renal failure. However, it is still necessary to be alert to its adverse reactions.

Effect of Intrapartum Fever Severity on Maternal and Fetal Outcomes

LIU Liheng, ZOU Liying, MI Xue, HOU Lei, WANG Xin

2024, 27(06):  699-703.  DOI: 10.12114/j.issn.1007-9572.2023.0318

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Background

Intrapartum fever is a common clinical manifestation in obstetrics, which increases the rates of cesarean section, vaginal instrumental delivery and neonatal asphyxia. The influencing factors of intrapartum fever include pregnancy comorbidities and complications, labor induction duration, labor analgesia, trial delivery time, temperature of delivery room, and number of pelvic examination. These factors can exist independently or be causal. Is it true that the higher maximum body temperature correlates with worse maternal and neonatal outcomes in women with intrapartum fever? The study on it is useful to guide the clinical prognosis and management strategies of pregnant women with intrapartum fever.

Objective

To investigate the effect of intrapartum fever and its severity on maternal and fetal outcomes during trial delivery of full-term singleton primipara.

Methods

A total of 994 full-term singleton primiparas who delivered in 2019 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University and diagnosed with intrapartum fever during labor were included as fever group, the full-term singleton primiparas without intrapartum fever who met the criteria were enrolled in a 1∶1 ratio as the control group during the same period. The general situation, complications, labor induction, delivery mode, and maternal and infant outcomes were compared between the fever group and control group. The fever group was further divided into 4 subgroups according to the degree of body temperature at delivery, including 142 cases in subgroup 1 with temperature of 37.3 to <37.5℃, 600 cases in subgroup 2 with temperature of 37.5 to <38 ℃, 213 cases in subgroup 3 with temperature of 38.0 to <38.5 ℃, 39 cases in subgroup 4 with temperature ≥38.5 ℃. General information, obstetric complications, labor induction, delivery mode, and maternal and fetal outcomes of the four subgroups were compared and analyzed.

Results

A total of 994 cases were included in the fever group and 987 cases in the control group. The proportions of labor induction and induced labor≥3 days in the fever group were higher than those in the control group (P<0.05) . The incidence of premature membrane rupture, gestational hypertension and gestational diabetes in the fever group was higher than the control group (P<0.05) . The rates of cesarean section, puerperal infection, neonatal asphyxia, amniotic fluid contamination neonatal NICU transfer in the fever group were higher than those in the control group (P<0.05) . There was no statistically significant difference between the two groups in terms of neonatal body mass (P>0.05) . There was no statistically significant difference in the rates of labor induction, proportion of induced labor≥3 days and incidence of premature rupture of fetal membranes, gestational hypertension and gestational diabetes among the subgroups (P>0.05) . The differences were not statistically significant when comparing the rates of cesarean delivery, puerperal infection, neonatal asphyxia, amniotic fluid contamination and neonatal NICU transfer among the subgroups (P>0.05) .

Conclusion

The incidence of maternal complications, labor induction, cesarean section, puerperal infection and neonatal asphyxia increased in patients with fever during labor, the severity of fever was not related to the mode of delivery and maternal and infant outcomes.

Distribution of Pharmacogenetic Polymorphisms and the Intervention Effects of Folic Acid Combined with Vitamin D in Community-based Patients with H-type Hypertension

PANG Aimei, GAO Wei, ZHANG Heng, PU Shuangshuang, GUO Lili, FAN Zirong, LIU Haixia, LIU Ruixia

2024, 27(06):  704-710.  DOI: 10.12114/j.issn.1007-9572.2023.0457

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Background

H-type hypertension seriously affects people's health and quality of life. Currently, the clinical treatment of hypertension mainly selects drugs based on the experience, and the antihypertensive effect is not ideal. It is urgent to explore the pharmacogenetic polymorphisms of antihypertensive drugs and provide individualized medication guidance for hypertensive patients.

Objective

To investigate pharmacogenetic polymorphisms and the intervention effects of folic acid combined with vitamin D in patients with H-type hypertension in Jinan community, and provide reference for the implementation of integrated precision medicine for hypertension.

Methods

From June 2020 to June 2022, 200 hypertensive patients with poorly controlled blood pressure in 20 community health service centers of Huaiyin District, Jinan City, Shandong Province were randomly selected as the research objects. Before treatment, the gene polymorphisms of five commonly used individualized antihypertensive drugs, including diuretics, β-blockers, angiotensin-converting enzyme inhibitors (ACEI) , calcium channel inhibitors (CCB) , angiotensin-Ⅱ receptor antagonists (ARB) , were detected. Patients were randomly divided into the gene-directed treatment group (genome group) and gene-directed synergistic folic acid and vitamin D treatment group (gene-directed group) , with 100 cases in each group. The genome group adjusted the drug according to the characteristics of the detected hypertension gene loci; the gene-directed group received folic acid and vitamin D in addition to the genomic therapy regimen. Sitting systolic and diastolic blood pressures in the morning without antihypertensive drugs were collected from patients at the initial intervention (M₀) , 3 months of intervention (M₃) , and 6 months of intervention (M₆) . Case status, adverse reactions and stroke were recorded, gene sequencing was performed, and serum homocysteine (Hcy) concentration was detected. Pearson correlation analysis or Spearman's rank correlation analysis were used to explore the correlation between sex, age, systolic blood pressure, diastolic blood pressure and Hcy.

Results

Gender (r_s=-0.463) , systolic blood pressure (r=0.181) and diastolic blood pressure (r=0.188) were correlated with Hcy level (P<0.05) . Among the 5 antihypertensive drug genes, CYP3A5 (A6986G) , CYP2C9 (c.1075A>C) , CYP2D6 (c.100C>T) were associated with polymorphism loci of drug metabolism enzyme genes, respectively. ADRB1, ACEI (I/D) , AGTR1 and NPPA were associated with the polymorphic loci of drug target sensitivity genes. Genome A6986G:CYP3A5*1/*1 (AA) , ACEI (I/D) :D/D, C.100 C>T:CYP2D6*1/*1 (CC) patients at M₃ and M₆ had lower diastolic blood pressure than M₀, A6986G:CYP3A5a1/a3 (AG) , ADRB1 C.1165 G>C:GG, c.1075A>C:CYP2C9*1/*3 (AC) , c.1075A>c:CYP2C9*3/*3 (CC) patients at M₆ had lower systolic and diastolic blood pressure than M₀, A6986G:CYP3A5*3/*3 (GG) , ADRB1 C.1165 G>C:CC, ACEI (I/D) :I/I, c.1075A>C:CYP2C9*1/*1 (AA) , AGTR1 C.1166A>c:AA, NPPA T2238C:TT, c.100 C>T:CYP2D6*10/*10 (TT) patients at M₃ and M₆ had lower systolic and diastolic blood pressure than M₀, ADRB1 C.1165 G>C:GC, ACEI (I/D) :I/D, c.100 C>T:CYP2D6*1/*10 (CT) patients at M₆ had lower systolic blood pressure than M₀, and lower diastolic blood pressure than M₀, the difference was statistically significant (P<0.05) . The results of intergroup comparison of Hcy levels showed that the Hcy level at M₃ and M₆ in the genome group was lower than the genome group, and the difference was statistically significant (P<0.05) . The results of intra-group comparison showed that Hcy level in the genome group at M₆ was lower than M₀, Hcy level in the gene-directed group at M₃ and M₆ was lower than M₀, and Hcy level at M₆ was lower than M₃, the differences was statistically significant (P<0.05) . The results of inter-group comparison of systolic and diastolic blood pressure showed that systolic and diastolic blood pressure of M₃ and M₆ gene-directed group were lower than the genome group, and the difference was statistically significant (P<0.05) . The results of intra-group comparison showed that systolic and diastolic blood pressure at M₆ in the genome group and gene-directed group were lower than M₀, and the systolic blood pressure at M₆ was lower than M₃, and the difference was statistically significant (P<0.05) .

Conclusion

There are differential expression of hypertension drug-related gene polymorphisms in community-based H-hypertensive patients, and the effect of individualized medication is remarkable. And combination therapy of folic acid and vitamin D can significantly reduce the level of H-hypertension.

Telemedicine Management in Stabilized Respiratory Rehabilitation of Elderly Patients with Moderate-to-severe Chronic Obstructive Pulmonary Disease: a Randomized Controlled Trial

YUAN Quan, LU Haiying, WANG Yi, LIU Yunxiao, YU Jiaqin, TIAN Fengzhao, LI Yao

2024, 27(06):  711-716.  DOI: 10.12114/j.issn.1007-9572.2023.0333

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Background

The number of chronic obstructive pulmonary disease (COPD) patients in China is huge, and respiratory rehabilitation training, as an important part of the management of COPD patients in the stabilization period, can effectively improve their lung function and quality of life, as well as reduce the burden on their families and society. Current data from Europe and the United States have shown that the implementation of respiratory rehabilitation under telemedicine management can improve the lung function and QOL of patients, however, there is a lack of relevant practice in China, especially in the west.

Objective

To assess the impact of respiratory rehabilitation training via telemedicine management in combination with conventional therapy on improving ventilatory capacity and lung function in elderly patients with moderate-to-severe COPD.

Methods

This study was a prospective randomized controlled study, enrolling consecutive COPD patients who attended the Fourth People's Hospital of Sichuan Province and five joint community clinics from June 2021 to June 2022. The included patients were randomly divided into the experimental group and control group by simple randomized grouping method using random number table. The control group received traditional long-term regular inhalation bronchodilator and oral medication, and the experimental group was guided by telemedicine on the basis of the treatment plan of the control group. A six-month study was conducted on two groups of patients, lung function, Borg score, 6MWT, and quality of life score (QOL score) were recorded at 1 month before and 1, 3, 6 months after intervention.

Results

The study subjects were divided into 72 cases in the control group and 73 cases in the experimental group, and there was no significant difference in gender, age and lung function at baseline [the forced expiratory volume in one second/predicted value ratio (FEV₁%pred) , and the ratio of the forced expiratory volume in one second to the forced vital capacity (FEV₁/FVC) ] between the two groups (P>0.05) . There was an interaction between time and group for dyspnea and mood in FEV₁%pred, FEV₁/FVC, 6MWT level and QOL score (P<0.05) . After 1, 3, and 6 months of intervention, FEV₁%pred, FEV₁/FVC, 6MWT, Borg score, and QOL score of the experimental group were better than those of the control group (P<0.05) ; FEV₁%pred, FEV₁/FVC, Borg score, 6MWT, and QOL scores at 3 and 6 months post-intervention were better than those at 1 month post-intervention in the experimental group (P<0.05) .

Conclusion

The use of telemedicine technology for respiratory rehabilitation of elderly moderate-to-severe COPD patients in the stable stage can effectively improve the pulmonary function, quality of life and the quality of survival of this group of patients after 3, 6-months intervention.

Analysis of Factors Influencing Hyperlipidemia in Female Polycystic Ovary Syndrome Patients with Normal Body Mass Index

LIU Yang, WANG Yu, CONG Jing, GONG Yi, HAN Buwei, WANG Kaiyue, ZHU Mengyi, ZHANG Bei, WU Xiaoke

2024, 27(06):  717-722.  DOI: 10.12114/j.issn.1007-9572.2023.0305

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Background

In recent years, women with polycystic ovary syndrome (PCOS) have had a higher prevalence of lipid metabolism disorders, which are strongly associated with obesity and insulin resistance (IR) . Higher levels of lipid metabolism have been also found in PCOS women with normal body mass index (BMI) , but there are fewer studies on dyslipidemia in this population.

Objective

To investigate the factors influencing the development of hyperlipidemia in PCOS women with normal BMI.

Methods

Based on the data of the clinical trial Effect of Acupuncture and Clomiphene on Live Birth Rate in Women with Polycystic Ovary Syndrome (PCOSAct) , a total of 428 subjects with complete baseline data and meeting the study criteria were selected. The evaluation criteria for determining hyperlipidemia included total cholesterol (TC) 6.22 mmol/L and/or triglycerides (TG) 2.26 mmol/L and/or low-density lipoprotein (LDL) 4.14 mmol/L and/or high-density lipoprotein (HDL) <1.04 mmol/L, which was used to divide patients into the hyperlipidemia group (n=138 patients) and no hyperlipidemia group (n=290 patients) . The demographic characteristics, sex hormones, glucose and lipid metabolism, as well as cardiac enzymes and liver function were compared between patients with hyperlipidemia and those without hyperlipidemia, and multivariate logistic regression analysis was used to explore the factors influencing hyperlipidemia in PCOS women with normal BMI.

Results

The prevalence of combined hyperlipidemia in PCOS women with normal BMI was 32.24% (138/428) , and the most common type of dyslipidemia was reduced HDL levels with a high prevalence (21.73%, 93/428) of a single phenotype. There were 138 cases in the hyperlipidemia group and 290 cases in the no hyperlipidemia group. The hyperlipidemic group had higher age, proportion of family history of diabetes, body mass, waist circumference, BMI, WHR, longer duration of attempted pregnancy, higher levels of free androgen index, fasting insulin, insulin resistance index (HOMA-IR) , LDL, TC, TG, apolipoprotein B, alanine aminotransferase, aspartate aminotransferase, LDH than the no hyperlipidemia group, and higher levels of sex hormone binding globulin, anti-mullerian hormone, HDL, apolipoprotein A, total bilirubin, and direct bilirubin lower than the no hyperlipidemia group (P<0.05) . Multivariate logistic regression analysis revealed that age, BMI, HOMA-IR, and LDH were independent risk factors for the development of hyperlipidemia in PCOS patients with normal BMI (OR=1.170, 1.348, 1.172, 1.009) , and sex hormone binding globulin was independent protective factor (OR=0.979, P<0.05) .

Conclusion

The incidence of hyperlipidemia in PCOS women with normal BMI was 32.24%. Age, BMI, HOMA-IR, LDH, and SHBG are influencing factors of the development of hyperlipidemia in women with PCOS, and clinical measures should be taken to prevent or delay the occurrence and development of hyperlipidemia in women with PCOS according to the causative factors.

Effect of Electroacupuncture on Inflammation Response and Ferroptosis in Rats Modeling Postoperative Cognitive Dysfunction

QIN Xiaoyu, ZHANG Binsen, ZHANG Xiaojia, LU Xiaoting, LIU Hongxin, WANG Chunai

2024, 27(06):  723-732.  DOI: 10.12114/j.issn.1007-9572.2023.0449

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Background

Postoperative cognitive dysfunction (POCD) is one of the major causes of increased postoperative morbidity and mortality in patients. The inflammatory response and ferroptosis are the principal hypotheses of the mechanism of POCD development. But the mechanism of electroacupuncture to improve learning and memory function in POCD patients is unclear.

Objective

To observe the effect of electroacupuncture on learning, memory, inflammatory cytokines and ferroptosis of hippocampal neurons in aged rats with POCD, so as to explore the mechanism of improving POCD by electroacupuncture.

Methods

From January 2022 to February 2023, 72 SD rats aged 18 to 20 months were selected and divided into 3 groups according to random number table method of control group (n=24) , model group (n=24) and electroacupuncture group (n=24) . According to the observation time points of 3 and 7 days postoperative, the rats in each group were divided into 2 the subgroups (3 d postoperative subgroup in control group, 7 d postoperative subgroup in control group, 3 d postoperative subgroup in model group, 7 d postoperative subgroup in model group, 3 d postoperative subgroup in electroacupuncture group, 7 d postoperative subgroup in electroacupuncture group) , with 12 rats in each group. POCD model was established by exploratory laparotomy, and Baihui and Neiguan points were stimulated by electroacupuncture. The Morris water maze device was used to detect the behavioral performance of rats. The contents of interleukin (IL) 6, IL-10, tumor necrosis factor alpha (TNF-α) in serum and hippocampus were detected by enzyme-linked immunosorbent assay, and lipid peroxides (LPO) and Fe²⁺ in hippocampus were detected. The protein expression levels of acyl coenzyme A synthetase long-chain family member 4 (ACSL4) , ferritin heavy chain 1 (FTH1) and lysophosphatidylcholine acyltransferase-3 (LPCAT3) in hippocampus were detected by Western Blotting. The ultrastructure of hippocampal neurons was observed by transmission electron microscopy.

Results

Group and time had no interaction effect on the escape latency of cognitive function training at 3 and 7 d postoperatively (P_interaction>0.05) , the main effect of training time on the escape latency of cognitive function training was significant (P_time<0.05) , and the main effect of group on the escape latency was not significant (P_group>0.05) . The escape latency of 3 d postoperative subgroup in model group was higher than that of 3 d postoperative subgroup in control group and 3 d postoperative subgroup in electroacupuncture group. The frequency of crossing platform and target quadrant residence time of 3 d postoperative subgroup in model group were lower than those of 3 d postoperative subgroup in control group and 3 d postoperative subgroup in electroacupuncture group; the frequency of crossing platform in 3 d postoperative subgroup in electroacupuncture group was lower than that of 3 d postoperative subgroup in control group (P<0.05) . The escape latency of 7 d postoperative subgroup in model group was higher than that of 7 d postoperative subgroup in control group and 7 d postoperative subgroup in electroacupuncture group, the frequency of crossing platform was lower than that of 7 d postoperative subgroup in control group, and the target quadrant residence time was lower than that of 7 d postoperative subgroup in control group and 7 d postoperative subgroup in electroacupuncture group (P<0.05) . Serum IL-6 and TNF-α in 3 d postoperative subgroup in model group were higher than those in 3 d postoperative subgroup in control group and 3 d postoperative subgroup in electroacupuncture group (P<0.05) . TNF-α in 3 d postoperative subgroup in electroacupuncture group was higher than that in 3 d postoperative subgroup in control group (P<0.05) , and IL-10 was higher than that in 3 d postoperative subgroup in control group and 3 d postoperative subgroup in model group (P<0.05) . Serum IL-6 was higher in 7 d postoperative subgroup in model group than in 7 d postoperative subgroup in control group, and TNF-α was higher than 7 d postoperative subgroup in control group and 7 d postoperatively subgroup in electroacupuncture group, and IL-10 was higher in 7 d postoperative subgroup in electroacupuncture group than the 7 d postoperative subgroup in control group and 7 d postoperatively subgroup in model group (P<0.05) . The levels of hippocampal IL-6 and TNF-α in 3 d postoperative subgroup in model group were higher than those of 3 d postoperative subgroup in control group and 3 d postoperative subgroup in electroacupuncture group, and the level of IL-10 was higher than that of 3 d postoperative subgroup in control group and 3 d postoperative subgroup in model group (P<0.05) . Hippocampal IL-6 and TNF-α levels in 7 d postoperative subgroup in model group were higher than those in 7 d postoperative subgroup in control group and 7 d postoperative subgroup in electroacupuncture group, and IL-10 in 7 d postoperative subgroup in electroacupuncture group was higher than that in 7 d postoperative subgroup in contol group and 7 d postoperative subgroup in model group (P<0.05) . Fe²⁺, LPO, ACSL4 and LPCAT3 in 3 d postoperative subgroup in model group were higher than those in 3 d postoperative subgroup in control group and 3 d postoperative subgroup in electroacupuncture group, Fe²⁺, LPO, ACSL4 and LPCAT3 in 3 d postoperative subgroup in electroacupuncture group were higher than those in 3 d postoperative subgroup in control group; FTH1 in 3 d postoperative subgroup in model group was lower than that in 3 d postoperative subgroup in control group and 3 d postoperative subgroup in electroacupuncture group, FTH1 in 3 d postoperative subgroup in electroacupuncture group was lower than that in 3 d postoperative subgroup in control group (P<0.05) . Fe²⁺, LPO, ACSL4 and LPCAT3 in 7 d postoperative subgroup in model group were higher than those in 7 d postoperative subgroup in control group and 7 d postoperative subgroup in electroacupuncture group, FTH1 in 7 d postoperative subgroup in model group was lower than that in 7 d postoperative subgroup in control group and 7 d postoperative subgroup in electroacupuncture group (P<0.05) . In 3 d and 7 d postoperative subgroups in model group, the structure of double nuclear membrane of cell nucleus was clear in the hippocampal field of vision, and the perinuclear space was not significantly widened, with irregular shape and uneven surface; the chromatin in the nucleus was concentrated and marginalized; a small amount of mitochondrial membranes in the cytoplasm were broken and the membrane structure disappeared; part of the endoplasmic reticulum expanded obviously; some myelin sheaths were broken and disorganized. The 3 d and 7 d postoperative subgroups in electroacupuncture group improved significantly compared with 3 d and 7 d postoperative subgroups in model group.

Conclusion

The imbalance of inflammatory cytokines and ferroptosis of neurons may be the important etiological mechanism for the development of POCD. Electroacupuncture can improve the learning and memory abilities in aged rats with POCD, and the mechanism of its brain protection may be related to the regulation of systemic and central inflammatory cytokines and the pathway of ferroptosis in neurons.

Effect of Press-needle Therapy on Prevention of Myelosuppression after Chemotherapy of Non-small-cell Lung Cancer Patients based on the Midnight-noon Ebb-flow Point Selection Theory

FAN Guohua, SUN Jingyun, JI Juan, XU Wenjing, ZHAO Juan

2024, 27(06):  733-738.  DOI: 10.12114/j.issn.1007-9572.2023.0118

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Background

Myelosuppression is one of the most common adverse effects of chemotherapy for lung cancer, in response to chemotherapy-related myelosuppression, modern medicine mostly adopts symptomatic treatment, but there are many limitations.

Objective

To investigate the effects of press-needle therapy on pevention of myelosuppression after chemotherapy of lung cancer patients based on the midnight-noon ebb-flow point selection theory.

Methods

A total of 142 non-small cell lung cancer (NSCLC) patients during first chemotherapy hospitalized in the respiratory department of Northern Jiangsu People's Hospital from July 2020 to June 2022 were selected and randomly divided into the control group (n=47) , press-needle group (n=48) and timing group (n=47) according to a prior computer-generated random number table and the developed allocation scheme. The control group received routine care measures, the press-needle group received press-needle therapy at acupoints such as Geshu acupoint, Pishu acupoint and Weishu acupoint on the basis of routine care measures, the timing group received press-needle therapy between 7 a.m. and 11 a.m on the day using midnight-noon ebb-flow method on the basis of routine care measures. The changes of blood routine indicators reflecting myelosuppression and the comfort scores before chemotherapy and 3rd, 7th, 14th, 21st days of chemotherapy were observed in the three groups.

Results

The white blood cell count and neutrophil count in the press needle group and timing group were higher than the control group, and the white blood cell count and neutrophil count in the timing group were higher than the press needle group on the 7th and 14th days of chemotherapy (P< 0.05) ; the platelet count in the press needle group and timing group were higher than the control group on the 7th and 14th days of chemotherapy (P< 0.05) . The comfort scores in the press needle group and timing group were higher than the control group on the 7th and 14th days of chemotherapy (P< 0.05) , the comfort scores in the timing group were higher than the press needle group on the 14th day of chemotherapy (P< 0.05) .

Conclusion

The timing press-needle therapy based on the midnight-noon ebb-flow point selection theory can effectively prevent myelosuppression, improve blood routine indicators including white blood cell count, neutrophil count and platelet count, and promot comfort in NSCLC patients after chemotherapy.

Effective Fraction Screening of Glycyrrhiza Radix on Preventing Respiratory Tract Injury Induced by Endotracheal Intubation

ZHANG Jie, DING Shengshuang, GUO Min, XUE Yang, XU Ziqing, HOU Huaijing, XUE Jianjun

2024, 27(06):  739-746.  DOI: 10.12114/j.issn.1007-9572.2023.0270

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Background

Postoperative sore throat (POST) is one of the common mild but unpleasant postoperative complications after general anaesthesia. There is evidence that Glycyrrhiza Radix can effectively reduce the incidence of POST, but its effective fraction remains unclear.

Objective

To screen the effective fraction of Glycyrrhiza Radix on preventing respiratory tract injury induced by endotracheal intubation.

Methods

From April 2021 to July 2022, 60 SPF-grade Wistar rats were randomized into the control group, endotracheal intubation group, lidocaine group, total polysaccharides group, total saponins group, total flavonoids group based on random number table method, with 10 rats in each group. The endotracheal intubation model was prepared for all groups except the control group. Before intubation, each treatment group was sprayed with a solution consisting of 1% lidocaine, total polysaccharides, total saponins, and total flavonoids at 1 mL/100 g (by body weight) to permeate the uvula and peri-soft palate tissue of rats, respectively. The control and endotracheal intubation groups were sprayed with an equal volume of 0.9% saline. After 2 hours of mechanical ventilation, the endotracheal tube was removed, and the pharyngeal mucosa tissues and blood samples of rats were collected under deep anesthesia. Pathological changes of rat pharyngeal mucosa and the expression levels of Toll-like receptor 2 (TLR2) and Toll-like receptor 4 (TLR4) were observed by hematoxylin-eosin staining (HE staining) and immunohistochemistry (IHC) ; the expression levels of inflammatory cytokines including serum tumor necrosis factor-α (TNF-α) , interleukin-2 (IL-2) , interleukin-4 (IL-4) , interleukin-10 (IL-10) , oxidative stress including superoxide dismutase (SOD) , malondialdehyde (MDA) , total antioxidant capacity (T-AOC) , and stress hormones including cortisol (Cor) , epinephrine (E) , and norepinephrine (NE) were measured by enzyme-linked immunosorbent assay (ELISA) .

Results

HE staining showed mucosal shedding and severe damage of submucosal structure accompanied by a large number of inflammatory cells infiltrated in the endotracheal intubation group; while milder damage of mucosal structure and less inflammatory cells were significantly reduced in the total saponins group. ELISA results showed that compared with the control group, the levels of TNF-α and IL-2 in the serum of rats increased significantly, and the levels of IL-4 and IL-10 decreased significantly in the endotracheal intubation group (P<0.05) ; compared with the endotracheal intubation group, the serum levels of TNF-α and IL-2 decreased, and the levels of IL-4 and IL-10 increased in the total saponins group (P<0.05) . Compared with the control group, the MDA level in the serum of rats was significantly increased, and the SOD and T-AOC levels were significantly decreased in the endotracheal intubation group (P<0.05) ; compared with the endotracheal intubation group, the MDA level decreased and the levels of SOD and T-AOC increased in the total saponins and flavonoids groups (P<0.05) . Compared with the control group, serum Cor, E, and NE levels significantly increased in the endotracheal intubation group (P<0.05) ; compared with the tracheal intubation group, serum Cor, E and NE levels were decreased in the total saponins group rats (P<0.05) . The IHC results showed that the average optical density (AOD) expressed by TLR2 and TLR4 in the endotracheal intubation group was higher than the control group (P<0.05) . The AOD expressed by TLR4 in the pharyngeal mucosal tissue of rats in the total saponins group was significantly lower than that of the endotracheal intubation group (P<0.05) .

Conclusion

Total saponin is the main effective fraction of Glycyrrhiza Radix for the prevention of respiratory tract injury caused by endotracheal intubation under general anesthesia.

Impact of ICD-11 Inclusion of TCM Codes on the Global Burden of Disease

ZHOU Jingjing, HE Kaiyue, LIU Ailing, ZHAO Lanhui, GAO Jing, ZHOU Shangcheng

2024, 27(06):  746-750.  DOI: 10.12114/j.issn.1007-9572.2023.0371

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Burden of disease measurement based on the International Statistical Classification of Diseases and Related Health Problems (ICD) codes have been widely used worldwide. However, most of the current studies are based on Western medical codes of ICD. As the internationalization of Traditional Chinese Medicine (TCM) , the inclusion of TCM codes in ICD-11 will facilitate the improvement of TCM disease diagnosis, the calculation of prevalence, survival, medication use, and treatment levels of TCM disease, which can further evaluate the disease burden of TCM diseases, promote medical decision making and rational allocation of health resources, thus further promoting the internationalization of TCM. However, the imperfection of TCM codes in ICD-11 and inadequate mapping between it and Western medicine codes, our national standards for TCM has also brought new challenges to the measurement of TCM disease burden. Based on the coding system of disease burden, this paper reviewed the deficiencies in the current research on the calculation of disease burden of TCM, and the impact of ICD-11 inclusion of TCM codes on the calculation of disease burden of TCM, made a preliminary comparison among the TCM codes and Western medical codes in ICD-11 and new national standard codes in China, to provide reference for the improvement of the calculation and coding of TCM disease burden. It is proposed that in the future, big data technologies can be used to facilitate the mapping between standardized TCM terms and ICD-11 TCM codes, ICD-11 TCM codes and Western medical codes, thus facilitating research on the burden of disease in TCM.

Analysis of Traditional Chinese Medicine Constitutions Attributable to the Burden of Wasting Thirst Disorder among the Middle-aged and Older adults in Guangzhou Based on ICD-11

ZHAO Lanhui, GAO Jing, ZHOU Shangcheng

2024, 27(06):  751-757.  DOI: 10.12114/j.issn.1007-9572.2023.0294

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Background

The 72nd World Health Assembly reviewed and adopted the International Classification of Diseases Eleventh Revision (ICD-11) , which for the first time included traditional medicine originating from traditional Chinese medicine (TCM) in its chapter coding, of which the code for wasting thirst disorder is SD71 (TM1) . At present, wasting thirst disorder is a high clinical prevalence disease, with middle-aged and older adults being the high incidence population, and TCM constitutions bias are risk factors for wasting thirst disorder. There was no research on the burden of TCM diseases and risk factors.

Objective

Based on the ICD-11 chapter on traditional medicine and the national standards of TCM, the burden of wasting thirst disorder among middle-aged and elderly in Guangzhou was calculated and attributed to the TCM constitutions. The role of TCM constitutions monitoring in health management was evaluated, providing reference for the prevention and treatment of wasting thirst disorder by TCM and the application of constitutions theory.

Methods

A cross-sectional survey was conducted in 2020 to investigate the prevalence of wasting thirst disorder and the distribution of TCM constitutions among middle-aged and elderly in Guangzhou. The comprehensive theory of Global Burden of Disease (GBD) , calculate the years of life lost (YLL) , years lived with disability (YLD) , and disability adjusted life year (DALY) of wasting thirst disorder in the middle-aged and elderly population in Guangzhou were used to evaluate the disease burden of wasting thirst disorder. Relative risk (RR) was used to assess the risk of different TCM constitutions for wasting thirst disorder in middle-aged and elderly people.

Results

A total of 1 576 middle aged and older adults in central Guangzhou were surveyed, 55 were lost, 1 521 valid questionnaires were recovered, and the effective response rate was 96.51%. Among them, 782 were male, aged 62 (56, 69) years; 739 were female, aged 62 (55, 70) years. The prevalence of wasting thirst disorder among middle-aged and elderly people in Guangzhou was 13.08%, with a standardized prevalence of 12.64%. The most distributed constitution among middle-aged and elderly people in Guangzhou were phlegm-dampness constitution, qi-deficiency constitution, and damp-heat constitution; among them, the most distributed constitutions in patients with wasting thirst disorder were phlegm-dampness constitution, yin-deficiency constitution, and qi-deficiency constitution. The DALY rate of wasting thirst disorder burden was 86.46‰, with a YLL rate of 4.86‰ and a YLD rate of 81.60‰. The proportion of single constitution and composite constitution was 48.98% and 51.02%, respectively. Yin-deficiency constitution was the risk constitution of wasting thirst disorder (RR=1.73, P<0.01) , which led to a disease burden of 33 092 DALY, with a DALY rate of 10.98, accouting for 12.70% of the disease burden in the middle-aged and elderly population with wasting thirst disorder. In terms of different age groups, phlegm-dampness constitution (RR=1.62, P<0.05) and yin-deficiency constitution (RR=1.80, P<0.05) were risk constitutions in the age group of 60-69 years, in which phlegm-dampness constitution resulted in a wasting thirst disorder burden of 18 530 DALY, with a DALY rate of 18.75‰, accounting for 21.63% burden of wasting thirst disorder in this age group; yin-deficiency constitution led to wasting thirst disorder burden of 10 520 DALY, with a DALY rate of 10.65‰, accounting for 12.28% of burden of wasting thirst disorder in this age group; the disease burden caused by the combination of phlegm-dampness constitution and yin-deficiency constitution was 26 780 DALY, with a DALY rate of 27.10 ‰, accounting for 31.26% of the burden of wasting thirst disorder in this age group. For different genders, male phlegm-dampness constitution (RR=2.29, P<0.01) and female yin-deficiency constitution (RR=2.27, P<0.01) were risk constitutions for wasting thirst disorder. The disease burden caused by phlegm-dampness constitution in middle-aged and elderly males was 45 017 DALY, resulting in a DALY rate of 30.96‰, accounting for 36.82% of the burden of wasting thirst disorder in middle-aged and elderly males. The burden of wasting thirst disorder caused by female yin-deficiency constitution was 28 753 DALY, resulting in a DALY rate of 18.43‰, accounting for 20.79% of the burden of wasting thirst disorder among middle-aged and elderly females.

Conclusion

The prevalence of wasting thirst disorder among middle-aged and older adults aged≥50 in Guangzhou is relatively high, with heavy disease burden. Yin-deficiency and phlegm-dampness constitutions are risk constitutions for wasting thirst disorder in middle-aged and elderly people. TCM constitutions monitoring and management can effectively reduce the burden of wasting thirst disorder .

Discussion on the Quality Control Test Method for a New Inhalation Drug Quantitative Assessment Instrument

PENG Yongyi, WU Zhongping, HUANG Jinhai, LIN Junfeng, CHEN Shubing, ZHENG Jinping, GAO Yi

2024, 27(06):  758-764.  DOI: 10.12114/j.issn.1007-9572.2023.0233

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Background

Administration of drugs by inhalation is a common route for the treatment of chronic airway diseases. The ability of patients to use an inhaler device is a key factor in the effectiveness of treatment. Recently, a new type of quantitative assessment instrument for inhalation drugs has been developed in China, which can measure peak inspiratory flow (PIF) and inspiratory volume (V_I) under conditions with various internal resistance of inhalers, thereby accurately assessing the ability of patients to use inhaler. However, there are no quality testing methods and adoption standards for this type of instrument at home and abroad.

Objective

To perform quality testing of the inhalation drug quantitative assessment instrument and evaluate its technical performance, in order to explore the application value of the method.

Methods

Various internal resistance of dry powder inhalers (DPI) was simulated by the inhalation drug quantitative assessment instrument (PF810) in 5 different gears (R1-R5 from low to high) . A standard flow/volume simulator was used to test the flow, volume and impedance performance of the PF810 for inhalation. The flow test was performed at a fixed volume (3.000 L) and different flow rates (in the range of 0-2.000 L/s, with 0.250 L/s as the interval stepwise) . The volume was carried out at three flow rates of low (0.500 L/s) , medium (1.000 L/s) and high (1.500 L/s) , and at different volumes (1.000 L as the interval stepwise in the range of 1.000-4.000 L) . The Bland-Altman analysis chart method of GraphPad prism 9.0 software was used to evaluate the consistency of PIF and V_I measurements of the inhalation drug quantitative assessment instrument with the actual values output by the simulator at different resistance gears.

Results

The results of quality control evaluation of flow detection showed that the percentages of repeatability, accuracy and linearity of flow detection meeting the performance requirements were 100.00% (40/40) , 95.00% (38/40) and 94.29% (33/35) . The accuracy and linearity of PF810 at R5 gear 1.500L /s and above did not meet the performance testing requirements, while those of other gears and flow rates met the requirements. The Bland-Altman consistency test showed 95% limit of agreement (LOA) of (-0.271- 0.107) L/s, with 96.00% (192/200) data points within the 95%LOA range. The results of volume test quality control evaluation showed that the pass rates of volume test repeatability, accuracy and linearity were all 100.00% (60/60, 60/60, 45/45) . The Bland-Altman consistency test showed that 95%LOA was (-0.058-0.017) L, and 100.00% (180/180) data points were within the 95%LOA range. The impedance measurement quality control evaluation results showed that the relative errors between the impedance value of PF810 and the internal resistance of the corresponding inhaler were all<5%.

Conclusion

In this study, a standard flow/volume simulator was used to measure the quality of inspiratory flow and volume of the inhalation drug quantitative assessment instrument at different levels of internal resistance. The method is simple and feasible, can evaluate the performance of this type of instrument and regularly detect and maintenance it objectively and scientifically, which was worthy of application and promotion.