Table of Content

15 May 2024, Volume 27 Issue 14

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USPSTF Recommendations Interpretation（3）

Interpretation of the Recommendation Statement by the USPSTF on the Screening for Chronic Obstructive Pulmonary Disease

YANG Ziyu, ZHANG Rui, LIAO Xiaoyang, LEI Yi, JIA Yu, YANG Rong, LI Dongze

2024, 27(14):  1661-1665.  DOI: 10.12114/j.issn.1007-9572.2023.0875

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Chronic obstructive pulmonary disease (COPD) is a common disease that seriously harms human health, and it is also a leading cause of death, with a large number of cases being underdiagnosed. Can COPD screening enable early diagnosis of the disease and improve patient outcomes? In 2022, the U.S. Preventive Services Task Force (USPSTF) updated its "Chronic Obstructive Pulmonary Disease Screening Recommendation Statement" (hereinafter referred to as the "Recommendation") for asymptomatic adults by evaluating the latest research evidence regarding the benefits and harms of COPD screening. Based on limited evidence, the USPSTF issused a 'D' statement (there is moderate certainty that the screening has no net benefit) and recommends against COPD screening for asymptomatic adults, which is consistent with the 2016 version. The current article interprets the principles of this Recommendation in the context of Chinese general practice.

Interpretation of Screening for Anxiety Disorders in Adults U.S. Preventive Services Task Force Recommendation Statement

LEI Yu, ZENG Xin, WANG Tingting, ZHOU Shipan, SHEN Jing, ZOU Chuan

2024, 27(14):  1665-1671.  DOI: 10.12114/j.issn.1007-9572.2024.0003

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Anxiety disorders are the most common mental illnesses and are often overlooked in primary care settings, with delays in initial treatment and significant impairment on patients' social function and quality of life. In 2023, the U.S. Preventive Services Task Force (USPSTF) published a recommendation statement on adult anxiety disorder screening in JAMA, along with the latest evidence report and systematic review results. The USPSTF suggests screening for anxiety in adults, including pregnant and postpartum women. However, current evidence on the risks and benefits of screening for anxiety in older adults is insufficient to determine the pros and cons of screening. This article combines the USPSTF statement with domestic and international research to provide an overview of several aspects: the current state of adult anxiety disorders domestically and internationally, a summary of the USPSTF recommendation statement, risk factors, early screening tools and their pros and cons, treatment, and the value of the statement for general practice guidance.

Article·Vertigo Section

Efficacy of Virtual Reality Vestibular Rehabilitation Training in Patients with Sudden Deafness and Vertigo: a Randomized Controlled Trial

ZHAO Yanan, HAN Shifan, LI Ying, ZHOU Liyuan, YANG Jie, WU Jiaxin, CHEN Ganggang

2024, 27(14):  1672-1677.  DOI: 10.12114/j.issn.1007-9572.2023.0272

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Background

Due to its unique advantages, virtual reality rehabilitation (VR) training has been widely used in the field of rehabilitation therapy, but there is a lack of study on its application efficacy in patients with sudden deafness and vertigo.

Objective

To observe the efficacy of coventional vestibular rehabilitation training and vestibular rehabilitation training assisted by VR technology in patients with sudden deafness and vertigo.

Methods

From January 2022 to January 2023, 84 patients with sudden deafness and vertigo were selected from the Department of Otolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University and randomly divided into the two groups, with 42 cases in each group. The control group was given drug therapy combined with coventional vestibular rehabilitation training, while the observation group was given vestibular rehabilitation training assisted by VR technology on the basis of drug therapy. The Dizziness Disorder Scale (DHI) and Hospital Anxiety and Depression Scale (HADS) were respectively used to evaluate the two groups before intervention, 7 and 14 days after the intervention.

Results

Finally 81 patients completed the trial, including 41 patients in the observation group and 40 patients in the control group. Group and time had interaction effects on DHI-Function (F), DHI-Emotion (E) and DHI-Physical (P) scores and total DHI score (P<0.05). The main effects of group and time on DHI sub-scores and total score were significant (P<0.05). There was no significant difference between the two groups in DHI sub-scores and total score before intervention (P>0.05) ; DHI sub-scores and total score in both groups after 7 and 14 days of intervention were lower than those before intervention (P<0.05). DHI sub-scores and total score in the observation group were higher than the control group after 7 and 14 days of intervention (P<0.05). Group and time had interaction effects on HADS-Anxiety Scale (A), HADS-Depression Scale (D) scores and total HADS score (P<0.05). The main effect of group and time on HADS sub-scores and total score was significant (P<0.05). There was no significant difference in HADS sub-scores and total score between the two groups before intervention (P>0.05). HADS sub-scores and total score in both groups after 7 and 14 days of intervention were lower than those before intervention (P<0.05). After 7 and 14 days of intervention, there was no significant difference in HADS sub-scores and total score between the two groups (P>0.05) .

Conclusion

Vestibular rehabilitation training is effective for patients with sudden deafness and vertigo, and the vestibular rehabilitation training assisted by VR technology can obviously improve patients' balance disorders and quality of life.

Clinical Characteristics and Related Factors of Patients with Cerebral Infarction in Acute Vestibular Syndrome

ZHANG Chunyue, FANG Liqun

2024, 27(14):  1678-1684.  DOI: 10.12114/j.issn.1007-9572.2023.0409

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Background

Acute cerebral infarction is a critical condition in patients with acute vestibular syndrome (AVS). AVS presents suddenly with severe symptoms. The sensitivity of CT in diagnosing acute cerebral infarction is low, and MRI, which is more accurate, is not always immediately available. This makes the diagnosis of acute cerebral infarction presenting as AVS challenging. Therefore, it is necessary to explore suitable examination and evaluation methods for patients with AVS.

Objective

To analyze the risk factors associated with acute cerebral infarction in patients with AVS, in order to provide a reference for the diagnosis of acute cerebral infarction in AVS and to maximize the critical treatment window for these patients.

Methods

A total of 102 patients with AVS admitted to the Department of Neurology, the Fourth Hospital of Harbin Medical University from April 2021 to July 2022 were included in the study. Clinical signs were recorded, and MRI results were used as the gold standard for the diagnosis of cerebral infarction. Patients were divided into the cerebral infarction group (n=16) and non-cerebral infarction group (n=86). The clinical characteristics of the two groups were compared. Univariate and multivariate Logistic regression analyses were used to explore factors influencing the occurrence of cerebral infarction in AVS. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of these factors.

Results

The proportions of patients with a history of smoking, alcohol consumption, positive Head-Impulse-Nystagmus-Test-of-Skew (HINTS) tests, and higher ABCD2 scores were significantly higher in the cerebral infarction group (P<0.05). Univariate Logistic regression analysis indicated that positive HINTS, ABCD2 scores, history of smoking, alcohol consumption, and hearing loss were factors influencing the occurrence of cerebral infarction. Multivariate analysis showed that positive HINTS (OR=99.043, 95%CI=8.120-1 208.090) and ABCD2 scores (OR=2.820, 95%CI=1.188-6.696) were the influencing factors (P<0.05). The areas under the ROC curve (AUC) for predicting cerebral infarction using combined indicators, positive HINTS, ABCD2 scores, history of smoking, alcohol consumption, and hearing loss were 0.949, 0.874, 0.734, 0.643, 0.649, and 0.604, respectively.

Conclusion

The proportion of non-cerebral infarction is higher in patients with AVS, with vestibular neuritis being the most common. Positive HINTS and ABCD2 scores are closely related to the occurrence of cerebral infarction in patients with AVS.

Clinical Characteristics of Benign Paroxysmal Positional Vertigo and the Influence of Psychological Factors on Residual Symptoms after Reduction

ZHOU Xinyang, YU Shujian, WANG Qian, YU Hong

2024, 27(14):  1685-1691.  DOI: 10.12114/j.issn.1007-9572.2023.0569

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Background

Benign paroxysmal positional vertigo (BPPV) is a common clinical disease characterized by self-limiting and easy recurrence. Manual reduction is effective but residual symptoms may occur in some patients after reduction. In recent years, there have been many studies focus on the influencing factors of therapeutic efficiency of BPPV, while the comparison among specific causes and factors influencing residual symptoms remain to be further investigated.

Objective

To analyze the clinical features of secondary BPPV, investigate the effect of etiological classification of BPPV on the recurrence rate, and clarify the risk factors of residual symptoms after BPPV reduction.

Methods

A total of 340 patients diagnosed with BPPV were enrolled in the vertigo clinic of the Department of Otorhinolaryngology Head and Neck Surgery and Otology Department of the First Hospital of Jilin University from April 2019 to April 2021, and all of them agreed to manual reduction. The included patients were divided into the primary BPPV (the primary group) and secondary BPPV (the secondary group) groups according to the presence or absence of primary disease. The secondary group was further divided into five subgroups according to different etiologies, including sudden sensorineural hearing loss (SSNHL), vestibular migraine (VM), Meniere disease (MD), vestibular neuritis (VN), and others (such as cranial and ear surgery, Hunt syndrome, temporal bone fracture, etc.). The clinical features and prognosis were compared between the primary group and the secondary group. Follow-up to 3 months after the first reduction, the patients were divided into the residual symptom group and non-residual symptom group according to the occurrence of residual symptoms. The differences were compared in clinical characteristics and scores of Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) at different periods (at diagnosis, 4 weeks after treatment, and 3 months after treatment) between the two groups, and the independent risk factors of residual symptoms after BPPV reduction were analyzed.

Results

Among the 340 patients, 184 (54.1%) were in the primary group and 156 (45.9%) were in the secondary group. Compared with the primary group, the patients of the secondary group were younger, and the proportion of patients who underwent more than two reductions was higher, the success rate of the first reduction was lower; and the recurrence rate within 3 months, incidence of residual symptoms, SAS score at diagnosis, and SDS score at diagnosis in the primary group were higher than those in the secondary group, with significant differences (P<0.05). There were statistically significant differences in the age of patients with different etiologies of secondary BPPV (P<0.05), and the age of patients with other etiologies (such as cranial and ear surgery, Hunt syndrome, temporal bone fracture, etc.) was lower than that of patients with SSNHL, VM, MD, and VN groups (P<0.05). There were no significant differences in gender, semicircular canal involvement, number of reductions, success rate of the first reduction, recurrence rate within 3 months, incidence of residual symptoms, SAS and SDS scores at different times among different etiology groups of secondary BPPV (P>0.05). There were 133 patients in residual symptom group and 207 patients in the non-residual symptom group. The main residual symptoms were dizziness (59.40%, 79/133), instability (24.06%, 32/133) and head and neck discomfort (9.77%, 13/133), and 6.77% (9/133) had two or more symptoms. The proportion of secondary BPPV and more than two reductions in the residual symptom group was higher than that in the non-residual symptom group (P<0.05), and the proportion of recurrence was less, the SAS and SDS scores at diagnosis, 4 weeks after treatment, and 3 months after treatment were higher than those in the non-residual symptom group (P<0.01). The results of multivariate Logistic regression analysis showed that SAS score at diagnosis (OR=1.231, 95%CI=1.117-1.357, P<0.001) and SDS score at diagnosis (OR=1.209, 95%CI=1.113-1.314, P<0.001) were influencing factors for the occurrence of residual symptoms after reduction in BPPV patients.

Conclusion

Secondary BPPV is characterized by a high incidence of residual symptoms and recurrence rate after reduction. Anxiety and depression can affect the occurrence of residual symptoms after reduction.

Article

Nested Case-control Study on the Impact of Stress Hyperglycemia Ratio on the Recurrence of Mild Acute Ischemic Stroke in the Elderly

GAO Kaiqian, YANG Yu, HU Yanfang, DONG Fafa

2024, 27(14):  1692-1698.  DOI: 10.12114/j.issn.1007-9572.2023.0847

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Background

In the context of aging in our country, the incidence and recurrence rates of acute ischemic stroke (AIS) are increasing year by year, and the mortality and disability rates are high. In recent years, the application of stress hyperglycemia ratio (SHR) in cardiovascular and cerebrovascular diseases has become more and more common, but its research in the recurrence of mild AIS is currently limited.

Objective

To explore the correlation between SHR and the recurrence of mild AIS in elderly patients within one year, and to provide a more theoretical basis for the prevention of AIS recurrence.

Methods

The study selected patients who were first diagnosed with mild AIS at the Shijiazhuang Fifth Hospital from May 2018 to January 2022. The study started with the diagnosis of mild AIS and ended one year after the diagnosis. A nested case-control study was conducted, and patients who were confirmed to have a recurrence within one year were included in the recurrence group. The non-recurrence group was matched at a ratio of 1∶3 based on 'diagnosis time, age, gender, infarction location, and whether they have diabetes'. A total of 70 patients were included in the recurrence group, and 210 patients were matched in the non-recurrence group. Through the Hospital Information System (HIS), patients gender, age, history of hypertension, history of atrial fibrillation, BMI, baseline NIHSS score, LDL-C, HbA_1c, random blood glucose on admission, etc. were collected, and the SHR was calculated. Multivariate conditional Logistic regression analysis was used to explore the correlation between SHR and the 1-year recurrence of mild AIS in elderly patients. This study is likely investigating the influence of the SHR on the recurrence of AIS within one year in elderly patients.

Results

The average age of the 280 patients was (71.9±6.4) years; 176 were male (62.9%), and 104 were female (37.1%) ; 88 patients (31.4%) had a history of diabetes. According to the median of the data, stress hyperglycemia ≥10 mmol/L was considered high, <10 mmol/L was considered low; SHR>1.04 was considered high, ≤1.04 was considered low. Multivariate conditional Logistic regression analysis showed that stress hyperglycemia (OR=2.983, 95%CI=1.488-5.977), SHR (OR=3.056, 95%CI=1.579-5.914) were factors affecting the 1-year recurrence of mild AIS in elderly patients (P<0.05). Among the 88 patients with a history of diabetes and mild AIS, 22 had a recurrence within 1 year, and 66 did not; among the 192 patients without a history of diabetes and mild AIS, 48 had a recurrence within 1 year, and 144 did not. The results of multivariate conditional Logistic regression analysis in the stratified analysis showed that SHR was still a factor affecting the 1-year recurrence of mild AIS in elderly patients with (OR=3.757, 95%CI=1.019-13.845) and without (OR=3.129, 95%CI=1.162-8.427) a history of diabetes (P<0.05). The relationship between SHR and the recurrence of mild AIS was further explored in the total population of elderly patients with mild AIS, divided into 4 subgroups at intervals of SHR=1.00, 1.40, 1.80. The results showed that SHR=1.41-1.80 and >1.80 were more likely to affect the 1-year recurrence of mild AIS in elderly patients than SHR≤1.0 (P<0.05), and SHR had no interaction with whether there was a history of diabetes (P_interaction>0.05, P_trend<0.05, OR=1.627) .

Conclusion

Regardless of whether elderly young AIS patients have diabetes, SHR has a consistent impact on the recurrence of elderly young AIS patients within one year, and both are its independent influencing factors; compared with stress blood glucose, SHR has a wider range of applications. The higher the SHR (increasing by 0.4 each time), the greater the risk of recurrence within one year for elderly young AIS patients (increasing by 0.627 times) .

Significance of Duration of Respiratory Events in Nocturnal Hypoxemia in Adults with Obstructive Sleep Apnea

WANG Jianying, REN Shouan

2024, 27(14):  1699-1707.  DOI: 10.12114/j.issn.1007-9572.2023.0397

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Background

The prevalence of obstructive sleep apnea (OSA) has been increasing year by year, but the current diagnostic criteria of apnea-hypopnea index (AHI) >5 times/h commonly used for OSA has gradually revealed drawbacks in the diagnosis, severity evaluation, treatment effect and long-term complications prediction of the disease. This study proposed that there is a need for more information about the duration of apnea-hypopnea for assessing OSA in addition to AHI.

Objective

To investigate the significance of duration of respiratory events in nocturnal hypoxemia in adults with OSA.

Methods

A total of 296 patients with suspected OSA who were admitted to the sleep monitoring room of the First Hospital of Shanxi Medical University from October 2021 to March 2022 were selected as the study subjects. Before PSG, the subjects underwent a physical examination in terms of height, body mass, neck circumference, and were asked about their sleep history, as well as history of hypertension and diabetes. The subjects were divided into three groups according to AHI of 5 times/h≤AHI<15 times/h as the mild OSA group (n=56), 15 times/h≤AHI<30 times/h as the moderate OSA group (n=62), AHI≥30 times/h as the severe OSA group (n=178). The three groups were compared for blood oxygen indexes[lowest oxygen saturation (LSpO₂), mean oxygen saturation (MSpO₂), baseline oxygen saturation (BSpO₂), oxygen desaturation index (ODI), oxygen saturation (SpO₂) below 90% in total sleep time (T90) ]and duration parameters of respiratory events [mean total apnea duration (MTAD), mean hypopnea duration (MHD), mean apnea-hypopnea duration (MAD), the longest apnea duration (LTAD), the longest hypopnea duration (LHD), the longest apnea-hypopnea duration (LAD), total apnea-hypopnea duration (TAD), AHI, percentage of apnea/hypopnea time from total sleep time (AHT%) ]. Spearman rank correlation analysis was used to investigate the correlation between respiratory event duration parameters and blood oxygen indexes. The OSA patients were divided into the short event group (short TAD subgroup, short AHT% subgroup, n=74) and long event group (long TAD subgroup, long AHT% subgroup, n=222) according to the median of TAD and AHT% (69.78 min and 14.33%, respectively), and the correlation of TAD, AHT% and AHI with blood oxygen indexes in each group was further analyzed.

Results

There were significant differences in gender, age, BMI, neck circumference, daytime sleepiness, history of hypertension and diabetes among the mild, moderate and severe OSA groups (P<0.05). ODI and T90 in the severe OSA group were higher than those in the mild and moderate OSA groups, and LSpO₂ and MSpO₂ were lower than those in the mild and moderate OSA groups (P<0.05) ; LSpO₂ in the moderate OSA group was lower than that in the mild OSA group, ODI and T90 were higher than that in the mild OSA group (P<0.05). MTAD, LTAD, TAD, AHT% in the severe OSA group were higher than those in the mild and moderate OSA groups, and MHD was lower than that in the mild and moderate OSA groups (P<0.05) ; LHD in the severe OSA group was lower than that in the moderate OSA group, LAD was higher than that in the mild OSA group. MTAD, LTAD, TAD and AHT% in the moderate OSA group were higher than those in the low OSA group (P<0.05). The scatter plot and loess fitting curve showed that the values of MTAD, MHD, MAD, LTAD, LHD and LAD all increased first and then decreased with AHI. TAD and AHT% were prolonged with increasing AHI. Spearman rank correlation analysis showed that AHI, MTAD, LTAD, TAD, AHT% were negatively correlated with LSpO₂ and MSpO₂, but positively correlated with ODI and T90 in OSA patients (P<0.05) ; MHD and LHD were positively correlated with LSpO₂ and MSpO₂, and negatively correlated with ODI and T90 (P<0.05) ; MAD was negatively correlated with ODI (P<0.05) ; LAD was negatively correlated with LSpO₂ (P<0.05). Further subgroup Spearman rank correlation analysis showed that TAD, AHT% and AHI were negatively correlated with LSpO₂ and positively correlated with ODI in short TAD subgroup, short AHT% subgroup, long TAD subgroup and long AHT% subgroup (P<0.05), and had no correlation with BSpO₂ (P>0.05) ; TAD, AHT%, and AHI were all negatively correlated with MSpO₂ and positively correlated with T90 in the long event group (P<0.05) .

Conclusion

Duration of respiratory events plays an important role in the evaluation of nocturnal hypoxemia in OSA patients, and can be used as a supplement to the existing diagnostic and evaluation index AHI, and indexes such as TAD and AHT% are even more representative than AHI in some cases. The combination of AHI and LSpO₂ with the duration of respiratory events can more objectively assess the severity of OSA patients.

Effects of Parental Marital Status on Negative Emotions and Nonsuicidal Self-injury Behaviors in Middle School Students: a Multicenter Cross-sectional Study

REN Xiaohong, CEN Yu, LUO Jing, ZHOU Yuling, HE Jinlong, LIN Cen, WU Dapeng, LUO Jiaming

2024, 27(14):  1708-1715.  DOI: 10.12114/j.issn.1007-9572.2023.0508

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Background

Effects of parental marital status on nonsuicidal self-injury (NSSI) behaviors and negative emotions in adolescents have been rarely reported, and the existing research sample size is relatively small.

Objective

To explore the association of parental marital status with negative emotions and NSSI in middle school students, to provide a reference for the prevention and control of NSSI in them.

Methods

A stratified random sampling method was used to conduct the questionnaire survey on students from 20 townships and 67 middle schools in Nanchong City and its surrounding areas from March to April 2020. The investigators input the questionnaire into the WJX.cn to generate QR codes, which were distributed to parents or student guardians by schools. The questionnaire, consisting of the General Information Questionnaire, Ottawa Self-injury Inventory (OSI) and the Chinese version of the Depression Anxiety Stress Scale-21 (DASS-21), was used to calculate the detection rates of NSSI, depression, anxiety and stress in middle school students to analyze the relevant factors affecting NSSI, depression, anxiety and stress in middle school students.

Results

A total of 8 785 students from 23 middle schools were surveyed, and 8 606 valid questionnaires were finally obtained, with a valid recovery rate of 98.0%. Among the 8 606 middle school students, there were 4 540 (52.8%) males, 4 066 (47.2%) females; 5 937 (69.0%) junior high school students, 1 028 (11.9%) senior high school students and 1 641 (19.1%) vocational high school students; 7 274 (84.5%) students in two-parent families, 787 (9.1%) students in divorced single-parent families, and 545 (6.4%) students in families with divorced and remarried parents. The detection rates of NSSI, depression, anxiety and stress in middle school students were 5.6% (486/8 606), 21.9% (1 884/8 606), 26.8% (2 305/8 606) and 12.3% (1 060/8 606), respectively. The results of multivariate Logistic regression analysis showed that among all middle school students, compared with boys, girls had a higher risk of NSSI (OR=2.363, 95%CI=1.946-2.868) and anxiety (OR=1.195, 95%CI=1.086-1.315) ; compared with junior high school students, vocational high school students had a higher risk of NSSI (OR=1.847, 95%CI=1.494-2.284), depression (OR=1.886, 95%CI=1.667-2.134), anxiety (OR=1.857, 95%CI=1.141-1.532) and stress (OR=1.527, 95%CI=1.309-1.781) ; compared with middle school students in two-parent family, students in divorced single-parent family had a higher risk of NSSI (OR=2.194, 95%CI=1.669-2.834), depression (OR=1.563, 95%CI=1.326-1.843), anxiety (OR=1.573, 95%CI=1.346-1.839) and stress (OR=1.417, 95%CI=1.153-1.741), students in families with divorced and remarried parents also had a higher risk of NSSI (OR=2.207, 95%CI=1.638-2.975), depression (OR=1.863, 95%CI=1.543-2.249), anxiety (OR=1.796, 95%CI=1.499-2.153) and stress (OR=1.821, 95%CI=1.453-2.282) ; compared to middle school students who are taken care of by their parents for a long time, those who are taken care of by their father alone, mother alone or grandparents alone for a long time had a higher risk of NSSI, depression and anxiety (by father alone: OR=2.045, 95%CI=1.366-3.062; OR=1.633, 95%CI=1.289-2.145; OR=1.373, 95%CI=1.069-1.762; by mother alone: OR=1.772, 95%CI=1.141-2.751; OR=1.435, 95%CI=1.095-1.882; OR=1.513, 95%CI=1.174-1.951; by grandparents alone: OR=2.465, 95%CI=1.918-3.168; OR=1.783, 95%CI=1.513-2.100; OR=1.843, 95%CI=1.577-2.154), students who were taken care of by mother alone or by grandparents alone had a higher risk of stress (OR=1.604, 95%CI=1.166-2.207; OR=1.678, 95%CI=1.375-2.049) (P<0.05) .

Conclusion

The NSSI, depression, anxiety and stress of middle school students are related to parental divorce and caregivers. Therefore, special attention and intervention should be given to middle school students in these situations.

Differences in Expression Levels of Haemopoietic Factors in Serum and Bone Marrow before and after Chemotherapy in Patients with Acute Myeloid Leukemia at Different Altitudes and Their Significance

SUN Qi, ZHOU Houfa, LI Wenqian, XIE Youbang, WANG Aibo

2024, 27(14):  1716-1722.  DOI: 10.12114/j.issn.1007-9572.2023.0324

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Background

Chemotherapy is a crucial treatment for patients with acute myeloid leukemia (AML), with bone marrow suppression as the most common toxic side effect. The development, proliferation, and differentiation of various types of blood cells are regulated by a variety of hematopoietic factors. However, it is not clear whether there is a difference in the expression level of hematopoietic factors after chemotherapy in patients with AML at different altitudes and the change pattern has not been clarified.

Objective

To investigate whether there are differences in the expression levels of hematopoietic factors in bone marrow and serum before and after chemotherapy and their changes in patients with AML at varying altitudes.

Methods

A total of 28 AML patients (non-M3 type) treated for the first time in the Department of Hematology at Qinghai Provincial People's Hospital (1 501 to 2 500 m in the middle altitude area) and the Department of Hematology of Xi-Jing Hospital, Air Force Medical University of PLA (500 to 1 500 m in low altitude area) from 2021 to 2022 were selected as the research subjects, and according to the altitude of the hospitals they visited, the AML patients were divided into the middle altitude group (13 cases) and the low altitude group (15 cases). The WHO grading criteria for acute and subacute toxicity of anticancer drugs was used to evaluate the myelosuppressive scores of the patients on days 8, 14, and 28 of chemotherapy. The expression levels of erythropoietin (EPO), FMS-like tyrosine kinase 3 ligand (Flt3-L), thrombopoietin (TPO), and interferon γ (IFN-γ) in serum and bone marrow before chemotherapy and on day 8, day 28 of chemotherapy were detected and compared by enzyme-linked immunosorbent assay.

Results

On days 14 and 28 of chemotherapy, the myelosuppressive scores of patients in the low-altitude group were higher than those in the middle-altitude group (Z=-1.975, P=0.048; Z=-2.049, P=0.040). On day 28 of chemotherapy, the serum and bone marrow EPO expression levels in the low-altitude group were higher than those in the middle-altitude group (P<0.05), the serum EPO expression level on day 28 of chemotherapy was lower than that on day 8 of chemotherapy, and the difference was statistically significant (P<0.05). On day 28 of chemotherapy, the serum and bone marrow expression levels of Flt3-L were higher in the low-altitude group compared to the middle-altitude group (P<0.05) ; the serum Flt3-L expression levels on day 8 and day 28 of chemotherapy were higher than those before chemotherapy in both groups, the bone marrow Flt3-L expression level on day 28 of chemotherapy was higher than that before chemotherapy in both groups (P<0.05). The serum TPO expression levels in the low-altitude group were higher than those in the middle-altitude group before chemotherapy, on the day 8 day 28 of chemotherapy (P<0.05) ; the serum TPO expression level in the low-altitude group was lower than that before chemotherapy on the day 8 of chemotherapy (P<0.05) ; the bone marrow TPO expression level in the low-altitude group was higher than that in the middle-altitude group on the day 28 of chemotherapy (P<0.05) ; the expression level of bone marrow TPO in the middle-altitude group on the day 28 of chemotherapy was lower than that before chemotherapy (P<0.05). There was no significant difference in serum and bone marrow IFN-γ expression levels between and within the two groups before and after chemotherapy (P>0.05) .

Conclusion

The expression levels of haemopoietic factors including EPO, Flt3-L, and TPO were higher during the recovery of myelosuppression after chemotherapy in AML patients at low altitude, compared to those at middle altitude. There was no significant difference between the two groups in terms of the hematopoietic inhibitory factor IFN-γ. Myelosuppression grades and degree after chemotherapy are more severe in AML patients at middle altitude than at low altitude.

Effect of Pre-transplant Skeletal Muscle Mass on Early Outcome of Allogeneic Hematopoietic Stem Cell Transplantation

WU Fangfang, DU Shanshan, DU Xin, XU Rufu, SUN Aihua, KONG Peiyan, GAO Lei, ZHANG Xi

2024, 27(14):  1723-1728.  DOI: 10.12114/j.issn.1007-9572.2023.0429

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Background

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an effective treatment for hematopoietic malignancies. Malnutrition is a common complication and negatively affects prognosis. Muscle mass has been shown to reflect the nutritional status of patients earlier than blood biochemical parameters such as albumin. However, the influence of pre-transplantation skeletal muscle mass (SMM) on the complications associated with early transplantation remains unclear.

Objective

To investigate the effect of pre-transplant SMM on the early outcomes of allo-HSCT, provide a clinical basis for nutritional interventions and prognosis improvement.

Methods

A study was conducted with 77 leukemia patients who underwent allo-HSCT at the Medical Center of Hematology, Xinqiao Hospital of Army Medical University from January to October 2022. Bioelectrical impedance analysis was used to assess skeletal muscle mass. The patients were divided into the normal SMM group of 36 cases and low SMM group of 41 cases according to their SMM. Baseline data, including personal and clinical details, were collected. Early post-transplant complications (within 30 days post-transplant) such as oral mucositis, gastrointestinal symptoms, infection and hematopoietic reconstitution time between the two groups were compared using SPSS 23.0 software.

Results

There was no statistically significant difference in the incidence of diarrhea, nausea, vomiting, and abdominal pain/gastritis incidence between the normal and low SMM groups (P>0.05). The incidence of oral mucositis, hypoalbuminemia, overt gastrointestinal bleeding, and infection was lower in the normal SMM group than in the low SMM group (P<0.05). The severity of oral mucositis in patients in the normal SMM group was lower than that in the low SMM group (P<0.001). Neutrophil implantation time and platelet implantation time were longer in patients in the low SMM group than in the normal SMM group (P<0.01) .

Conclusion

The pre-transplant patients had a high incidence of low SMM. The low SMM before transplantation correlates with the occurrence of oral mucositis, hypoalbuminemia, overt gastrointestinal bleeding, and infections, as well as extended neutrophil and platelet engraftment time in the early transplantation period, and patients should be screened as early as possible prior to transplantation to boost SMM and improve early post-transplant outcomes.

Construction and Preliminary Validation of Bathing with Wounds at Home Scheme for Patients with Traumatic Wounds

ZHAO Ting, JIANG Qixia, XU Huili, LU Xian, CHAO Hongfang

2024, 27(14):  1729-1734.  DOI: 10.12114/j.issn.1007-9572.2023.0190

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Background

Trauma is a highly prevalent and costly global health problem. Prevention and control of infection is a major challenge in the management of traumatic wounds, while prolonged absence of skin washing after trauma will increase the incidence of wound infection, as well as the discomfort. Although many patients are willing to take a bath after trauma, the timing and method of bathing remains unclear. Therefore, it is necessary to build an appropriate scheme of bathing with wounds to keep the skin and wounds clean.

Objective

To construct a bathing with wounds at home scheme suitable for patients with traumatic wounds in China, and to provide a feasible care scheme for keeping the skin of trauma patients clean and improving the outcome of wound healing.

Methods

Database at home and abroad were searched to obtain original literature, the first draft of the items of bathing with wounds at home scheme for patients with traumatic wounds was formulated through evidence-based analysis, generalization, group discussion. Fifteen wound care experts with associate or higher titles were included, and Delphi consultation was used to modify and improve the bathing with wounds scheme, with an interval of one week for each round of correspondences, the reliability of the consultation results was evaluated by the expert positive and authority coefficients. The consistency of the consultation results was evaluated by the coefficient of variation, a revised draft was formulated with terminated consultation when the coefficient of variation less than 0.25, which means that the expert opinions tend to be consistent. Thirty patients with traumatic wounds were enrolled in the pre-test, Likert 5-point scale was used to verify the convenience, safety and patient compliance of the bathing with wounds scheme, and the final scheme was developed after discussion and modification.

Results

After the inclusion of 23 related papers, the first draft of bathing with wounds scheme was developed through evidence-based analysis and discussion, involving three first-level items (including preparation befor bathing, bathing operation and treatment after bathing), seven second-level items, nine third-level items and four fourth-level items. The opinions of the 15 experts converged after 2 rounds of correspondence, with recall rates of 93.75% and 100.00%, with authority coefficients of 0.947 and 0.957, respectively. The variation coefficients of importance and maneuverability of each item in the first round were 0-0.25 and 0-0.23, and those in the second round were 0.09-0.18 and 0.07-0.14, respectively, a total of 2 items were deleted, 5 items were modified and 2 items were added, resulting in a revised draft. The 30 enrolled patients with traumatic wounds took baths (2.70±0.47) times per week according to the bathing scheme, with the average bath time of 10-15min, convenience and compliance scores of (4.67±0.48) and (4.70±0.47), and no bathing-related adverse events and wound infection occurred.The pre-test proved that the bathing plan was safe、reliable、simple and have good patient compliance. The final draft of the bathing with wounds scheme for traumatic wound patients included three first-level items, eight second-level items, nine third-level items and three fourth-level items.

Conclusion

In the construction process of the bathing with wounds scheme for traumatic wound patients, the positive and authority coefficients of experts are high, which has been unanimously approved by corresponding experts. The compliance of 30 patients with traumatic wounds in the pre-test was high, suggesting that the bathing with wounds scheme is safe and convenient, which can be applied to bathing with wounds at home for patients with traumatic wounds in China.

Article·Epidemiological Study

Current Situation and Trends in the Disease Burden of Dental Caries in China, 1990-2019

HUANG Gang, CAO Guiying, LIU Min

2024, 27(14):  1735-1741.  DOI: 10.12114/j.issn.1007-9572.2023.0494

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Background

Dental caries is one of the most common noncommunicable diseases worldwide, affecting more than one-third of the global population. The analysis of the current situation and trends in the disease burden of dental caries may provide a reference for the prevention and control strategies of dental caries.

Objective

To analyze the current situation and trends in the incidence, prevalence and years lived with disability (YLD) of dental caries in China and provide a reference for the development of the prevention and control of dental caries.

Methods

Data on the incidence, prevalence and YLD of caries of deciduous teeth and permanent teeth between 1990 and 2019 in China were extracted from the 2019 Global Burden of Disease (GBD) study. The percentage change in the counts of incident cases, prevalent cases and YLD of caries of deciduous teeth and permanent teeth from 1990 to 2019 was calculated, and Joinpoint regression model was used to analyze the annual percentage change (APC) and average APC (AAPC) in age-standardized rates of incidence, prevalence and YLD between 1990 and 2019 in China.

Results

Compared with 1990, the counts of incident cases, prevalent cases and YLD of caries of deciduous teeth in China in 2019 decreased by 25.69%, 28.74% and 28.63%, respectively; the counts of incident cases, prevalent cases and YLD of caries of permanent teeth in China in 2019 increased by 17.41%, 15.84% and 15.07%, respectively. In all age groups in 2019, the highest incidence rate (118.96%) of caries of deciduous teeth was observed in children aged 5 to 9 years, as well as the highest prevalence rate (53.08%) and YLD rate (20.40/100, 000) of caries of deciduous teeth in children aged 1 to 4 years. The highest incidence rate (62.30%), prevalence rate (32.19%), and YLD rate (32.41/100 000) of caries of permanent teeth were observed in adults aged 20 to 24 years in 2019. Joinpoint regression analysis showed that the age-standardized rates of incidence (AAPC=0.21%, 95%CI=0.19% to 0.22%), prevalence (AAPC=0.03%, 95%CI=0.01% to 0.05%) and YLD (AAPC=0.03%, 95%CI=0.01% to 0.05%) of caries of deciduous teeth showed an overall upward trend in China between 1990 and 2019, and the age-standardized rates of incidence (AAPC=-0.05%, 95%CI=-0.05% to -0.04%), prevalence (AAPC=-0.23%, 95%CI=-0.32% to -0.14%) and YLD (AAPC=-0.22%, 95%CI=-0.31% to -0.13%) of caries of permanent teeth showed a downward trend in China between 1990 and 2019.

Conclusion

From 1990 to 2019, the burdens in caries of deciduous teeth in China showed an increasing trend, while the burdens in caries of permanent teeth caries showed a decreasing trend but remained serious in China. Caries prevention should not only be limited to children, but should include people of all age groups.

Disease Burden of Gallbladder Cancer in China from 1990 to 2019 and the Analysis of Its Future Trends

LIU Shanshan, LI Chuyi, ZHENG Ying, LU Lixia, LI Bin, YU Xiaohui, DANG Zheng

2024, 27(14):  1742-1749.  DOI: 10.12114/j.issn.1007-9572.2023.0709

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Background

Gallbladder cancer is featured by difficult early detection, poor treatment effectiveness and high mortality. An in-depth epidemiology research of gallbladder cancer can provide valuable data for the formulation of prevention and treatment strategies for gallbladder cancer.

Objective

To analyze the trend of disease burden of gallbladder cancer in China from 1990 to 2019, and to estimate its onset age, period, cohort effects and future trends.

Methods

Data of disease burden of gallbladder cancer, including the incidence, prevalence, mortality, disability adjusted life year (DALYs) rate and corresponding standardized rates in China from 1990 to 2019 were extracted from the 2019 Global Burden of Disease Research (GBD 2019) database from March to June 2023. The annual percentage change (APC) and average annual percentage change (AAPC) were calculated using Joinpoint to analyze the trend of disease burden of gallbladder cancer in China from 1990 to 2019. A Bayesian age-period-cohort analysis (BAPC) model was created to predict the incidence of gallbladder cancer in China from 2020 to 2030.

Results

From 1990 to 2019, the standardized incidence rate of gallbladder cancer in China significantly rose from 1.58/100 000 in 1990 to 2.01/100 000 in 2019, with the AAPC of 0.82% (95%CI=0.65%-1.00%, P<0.001). The standardized prevalence significantly rose from 1.64/100 000 in 1990 to 2.40/100 000 in 2019, with the AAPC of 1.34% (95%CI=1.14%-1.54%, P<0.001). The standardized mortality significantly rose from 1.61/100 000 in 1990 to 1.82/100 000 in 2019, with the AAPC of 0.40% (95%CI=0.24%-0.56%, P<0.001). The standardized DALYs rate significantly rose from 35.18/100 000 in 1990 to 37.71/100 000 in 2019, with the AAPC of 0.25% (95%CI=0.12%-0.38%, P<0.001). The BAPC model revealed that the net drift values for the incidence and mortality of gallbladder cancer in China from 1990 to 2019 were 0.99 (95%CI=0.81-1.18) and 0.42 (95%CI=0.21-0.63), respectively. The incidence and mortality of gallbladder cancer increased with age, and the incidence of gallbladder cancer achieved the peak in people aged 80 years and above. The risk of onset and death of gallbladder cancer showed a decreasing trend at first and then an increasing trend followed by a decreasing trend over time, both of which peaked from 2005 to 2009. In addition, the risk of onset and death of gallbladder cancer showed an increasing trend at first and then a decreasing trend over the time of birth cohort. The BAPC model predicted that the standardized incidence, morbidity, mortality and DALYs rate of gallbladder cancer in China will show a slight upward trend from 2020 to 2030.

Conclusion

From 1990 to 2019, the standardized incidence, prevalence, mortality and DALYs rate of gallbladder cancer in China showed an upward trend, and the disease burden was still serious. The prevention and treatment of gallbladder cancer among men and the elderly, and vigorous propaganda of medical knowledge about cancer prevention, biliary disease control and promotion of healthy lifestyles should be strengthen to reduce the disease burden of gallbladder cancer.

Article·Evidence-based Medicine

Risk Factors for Severe Mycoplasma Pneumoniae Pneumonia in Children: a Meta-analysis

YANG Shuo, LIU Xinying, WANG Huizhe, LI Huanmin, LI Xinmin

2024, 27(14):  1750-1760.  DOI: 10.12114/j.issn.1007-9572.2023.0737

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Background

In recent years, the incidence of Mycoplasma pneumoniae pneumonia in children has continued to rise, with a corresponding increase in the number of severe Mycoplasma pneumoniae pneumonia, attracting widespread attention from clinical physicians. Understanding the risk factors associated with severe Mycoplasma pneumoniae pneumonia with the aim to determine the severity of the condition in affected children, prevent the occurrence of severe cases, and reduce sequelae has been a focal point in research. Although numerous studies have been conducted on the risk factors of severe Mycoplasma pneumoniae pneumonia, variations in time and geographical regions of the studies necessitate a systematic review and analysis for a comprehensive understanding.

Objective

To systematically review the risk factors for severe Mycoplasma pneumoniae pneumonia.

Methods

CNKI, Wanfang Data, VIP, CBM, Duxiu, Yiigle, Cochrane Library, PubMed, Embase, Web of Science, Science Direct, and BioMed Central were searched for studies related to risk factors of severe Mycoplasma pneumoniae pneumonia in children from inception to August 2023. Two investigators independently screened literature, extracted data, and assessed the bias risk of included studies. Meta-analysis was performed using Stata 14.0 and RevMan 5.4 software.

Results

A total of 22 retrospective case-control studies involving 4 531 childre were included. Meta-analysis showed that C-reactive protein (CRP) (OR=1.92, 95%CI=1.72-2.15, P<0.000 01), erythrocyte sedimentation rate (ESR) (OR=2.61, 95%CI=2.12-3.22), P<0.000 01), procalcitonin (PCT) (OR=2.60, 95%CI =1.43-4.75, P=0.002), D-dimer (OR=4.36, 95%CI=2.93-6.50, P<0.000 01), white blood cell count (WBC) (OR=1.98, 95%CI=1.66-2.36, P<0.000 01), lower lobe lesions (OR=5.70, 95%CI=3.48-9.35, P<0.000 01), large patchy lesions (OR=6.37, 95%CI=4.09-9.92, P<0.000 01), high Mycoplasma pneumoniae antibody titers (OR=2.83, 95%CI=1.78-4.49, P<0.000 1), lactate dehydrogenase (LDH) (OR=1.03, 95%CI=1.00-1.05, P=0.05), and duration of fever (OR=8.33, 95%CI=3.38-20.56, P<0.000 01) were positively correlated with severe Mycoplasma pneumoniae pneumonia in children.

Conclusion

Elevated inflammatory markers (CRP, ESR, PCT, LDH, WBC), the presence of characteristic imaging changes (large patchy consolidation, lower lobe lesions), high Mycoplasma pneumoniae antibody titer, elevated D-dimer, and prolonged fever duration may be risk factors for severe Mycoplasma pneumoniae pneumonia in children. Future high-quality studies are needed to further explore the relationship of other clinical, radiographic, and laboratory findings with severe Mycoplasma pneumoniae pneumonia in children, and develop prognostic models based on identified risk factors.

Ligustrazine Injection in the Treatment of Acute Ischemic Stroke: a Bayesian Network Meta-analysis

NIU Jingyuan, CHEN Huisheng, YU Jiaxiang, CUI Yu

2024, 27(14):  1761-1774.  DOI: 10.12114/j.issn.1007-9572.2023.0645

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Background

Acute ischemic stroke (AIS) is a serious cerebrovascular disease, which causes a heavy burden on society and patients. Ligustrazine injection has been widely used in the treatment of AIS with significant efficacy, but there is still a lack of direct or indirect comparison between ligustrazine injections.

Objective

To systematically evaluate the efficacy and safety of ligustrazine injection in the adjuvant treatment of AIS within 72 hours.

Methods

CNKI, Wanfang Data Knowledge Service Platform, VIP, PubMed, Cochrane Library, Embase, and Web of Science databases were searched for randomized controlled trials (RCTs) about the efficacy and safety of ligustrazine injection in the treatment of AIS from inception to April 2023. Literature was independently screened, extracted and quality assessed by 2 investigators using the Cochrane Evaluation Tool. RevMan 5.3, Stata 17, Addis and RStudio software were used to statistically compare and rank the efficacy and safety of different types of ligustrazine injection.

Results

A total of 71 papers involving 7 304 cases were included, and the interventions included Salvia Miltiorrhiza Ligustrazine Injection (DSCXQ), Shenxiong Glucose Injection (SXPTT), Xingxiong Sodium Chloride Injection (XXLHN), Ligustrazine Phosphate Injection (LSCXQ) and Ligustrazine Hydrochloride Injection (YSCXQ) combined with conventional western medical therapy (CT), respectively, and CT alone. Direct Meta-analysis results showed that in improving all the outcome indicators of AIS, the total effective rate, NIHSS score, fibrinogen level, and incidence of adverse reactions of ligustrazine injection combined with CT were better than those of CT alone (P<0.05). The results of network Meta-analysis showed that the order of cumulative probability in total effective rate was SXPTT+CT (0.60) >YSCXQ+CT (0.20) >LSCXQ+CT (0.15) >DSCXQ+CT (0.03) >XXLHN+CT (0.02) >CT (0) ; the order of cumulative probability in improving NIHSS score was SXPTT+CT (0.55) >XXLHN+CT (0.26) >YSCXQ+CT (0.12) >DSCXQ+CT (0.07) >CT (0) ; the order of cumulative probability in reducing fibrinogen level was XXLHN+CT (0.32) >LSCXQ+CT (0.22) >DSCXQ+CT (0.17) >SXPTT+CT (0.15) >YSCXQ+CT (0.14) >CT (0) ; the order of cumulative probability in safety was SXPTT+CT (0.79) >XXLHN+CT (0.13) >CT (0.04) >DSCXQ+CT (0.03) >YSCXQ+CT (0.01) .

Conclusion

Ligustrazine injection is effective and safe in adjuvant treatment of AIS, among which Shenxiong glucose injection was the best in total effective rate and improving NIHSS scores, with the least adverse reactions; Xingxiong sodium chloride injection has the most advantages in fibrinogen level.

Review & Perspectives

Research Progress on the Changes of Intestinal Barrier and Possible Mechanism after Traumatic Central Nervous System Injury

WANG Fangfang, ZHU Li, XING Jiajia, PANG Rizhao, GOU Xiang, ZHANG Anren

2024, 27(14):  1775-1781.  DOI: 10.12114/j.issn.1007-9572.2023.0293

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Traumatic central nervous system injury can cause imbalance in intestinal microenvironmental homeostasis by disrupting intestinal barrier function, while the disturbed intestinal microenvironment can react on the central nervous system and aggravate the secondary injury of it. A large number of studies suggest that the intestinal barrier plays an important role in the pathophysiological process of traumatic central nervous system injury and can be an important target for the action of central nervous system injury. This paper reviews the structural and functional changes of intestinal microbial, chemical, mechanical and immune barriers after traumatic central nervous system injury and their bidirectional interaction with the central nervous system, summarizes the possible mechanisms leading to the disruption of intestinal barrier, including malnutrition, ischemia-reperfusion injury, inflammatory response and the release of neurotransmitters and hormones, to provide theoretical basis and new ideas for the development of research on the intestinal microenvironment after traumatic central nervous injury.

Progress of Heme Oxygenase-1 Mediated Ferroptosis in Non-alcoholic Fatty Liver Disease

CAO Jiacen, ZHANG Hongkun, ZHAO Wen, NAN Yuemin, LI Dongdong

2024, 27(14):  1782-1788.  DOI: 10.12114/j.issn.1007-9572.2023.0266

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Ferroptosis plays an important role in the progression of non-alcoholic fatty liver disease (NAFLD) as a novel mode of programmed cell death. Heme oxygenase-1 (HO-1), acting as an inducible oxidase, has been shown the capability of alleviating oxidative stress and hepatocyte necrosis to prevent or delay the progression of NAFLD. However, the mechanism of HO-1 regulating ferroptosis and affecting the development of NAFLD remains inadequately explored. This review provided a systematic and comprehensive summary of the effects of HO-1 on NAFLD by regulating ferroptosis, and discussed the mechanism of HO-1 in preventing the development of NAFLD by summarizing the relevant literature in recent years, and showed that HO-1 regulates ferroptosis in NAFLD through the generation of antioxidants (such as bilirubin and CO), activation of the System Xc, and facilitation of ferrous ion accumulation, in order to provide a theoretical basis for targeting HO-1 gene therapy for NAFLD by methods such as pharmacological interventions and provide a reference for further research.