Table of Content

20 July 2024, Volume 27 Issue 21

Previous Issue    Next Issue

Guidelines Interpretation

Interpretation of the 2023 ESPEN Guideline on Nutritional Support for Polymorbid Medical Inpatients

WU Taiqin, GAN Xiuni, GAO Yan, ZHANG Huan, YANG Li

2024, 27(21):  2557-2564.  DOI: 10.12114/j.issn.1007-9572.2023.0824

Asbtract ( )   HTML ( )   PDF (1313KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Due to the accelerating trend of aging and transformation of residents' lifestyles and behaviors in China, multiple chronic conditions have become a major public health challenge. The phenomenon of comorbidities complicates patients' conditions and poor nutritional status, causing a heavy burden on patients' health and society. In 2018, the European Society for Clinical Nutrition and Metabolism (ESPEN) published the ESPEN Guidelines on Nutritional Support for Polymorbid internal medicine patients, which provides 22 recommendations and four statements on nutritional screening, assessment, requirements, monitoring and procedure of intervention for polymorbid medical inpatients. Based on continuously updated research evidence, the 2018 version of the guideline was updated by the ESPEN Guideline Working Group in June 2023, ESPEN Guideline on Nutritional Support for Polymorbid Medical Inpatients, to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards. This article interprets and focuses 15 key points of the guideline, include nutritional screening and assessment, oral nutritional supplements, enteral nutrition and parenteral nutrition, estimation of energy requirements, protein targets, micronutrients supplementation, disease-specific nutritional supplementation, early nutritional support, post-discharge nutritional support, monitoring of physical functions, energy and protein requirements, organizational changes in nutritional support, impact of underlying diseases on nutritional support, drug-nutrient interactions and nutritional biomarkers. In order to provide guidance for nutritional management of polymorbid patients in China.

Original Research

Correlation between Residual Cholesterol and Carotid Atherosclerosis in Menopausal Women

WU Huimin, WU Yuanmei, SHEN Xueyang, GE Zhaoming

2024, 27(21):  2567-2571.  DOI: 10.12114/j.issn.1007-9572.2023.0821

Asbtract ( )   HTML ( )   PDF (1341KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Carotid atherosclerosis (CAS) is a significant indicator of early systemic atherosclerosis. Previous studies have demonstrated a close relationship between elevated remnant cholesterol (RC) levels and the pathogenesis of CAS. However, limited information is available regarding the association between RC and the development of CAS in menopausal women.

Objective

To investigate the correlation between RC and the pathogenesis of CAS in menopausal women.

Methods

A total of 307 menopausal women from Fengxiang Town, Anding District, Dingxi City were selected as the research subjects. These women had participated in the national high-risk stroke screening project and completed carotid artery ultrasound examination between January 2020 and October 2023. General information on the ordinary people was collected and participants' characteristics of the carotid artery intima were analyzed by means of using color doppler ultrasound. Based on the cervical ultrasound results, the subjects were divided into CAS group and non-CAS group. Spearman rank correlation analysis was used to explore the correlation between RC and other risk factors for CAS. Furthermore, multifactor Logistic regression was employed to analyze and explore the correlation between RC and CAS in menopausal women.

Results

The findings revealed that participants in the CAS group (n=130) has higher levels than those in the non-CAS group (n=177) in terms of menopausal female age, history of stroke and transient ischemic attack (TIA), fasting plasma glucose (FPG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), RC and pulse pressure (P<0.05). Spearman rank correlation analysis indicated a positive correlation between RC and FPG as well as TC (r_s=0.113, 0.280, P<0.05), while a negative correlation was observed with LDL-C (r_s=-0.112, P<0.05). Furthermore, multivariate logistic regression analysis identified high RC levels (OR=1.539, 95%CI=1.185-1.999, P=0.001), age (OR=1.059, 95%CI=1.003-1.117, P=0.038), and history of stroke and TIA (OR=1.910, 95%CI=1.047-3.485, P=0.035) as risk factors for the onset of CAS in menopausal women. The menopausal women were further divided into high RC (RC≥0.70 mmol/L, n=155) and low RC (RC<0.70 mmol/L, n=152) groups based on the median RC. The high RC group had a higher proportion of women with dyslipidemia, CAS, waist circumference, BMI, and TG compared to the low RC group (P<0.05). Additionally, the high RC group had lower levels of high density lipoprotein cholesterol (HDL-C) compared to the low RC group (P<0.05) .

Conclusion

High RC levels are associated with CAS in menopausal women and may be an independent risk factor for CAS in menopausal women.

Effect of Outpatient Education on Blood Glucose Profile of Type 2 Diabetes Mellitus Patients Based on the Results of Continuous Glucose Monitoring

ZHOU Xiao, ZHOU Yunting, KONG Xiaocen, LIU Xiaomei, YUAN Lu, JING Ting, WANG Weiping, LI Huiqin

2024, 27(21):  2572-2577.  DOI: 10.12114/j.issn.1007-9572.2023.0769

Asbtract ( )   HTML ( )   PDF (1420KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Continuous glucose monitoring (CGM) is rarely applied to outpatient treatments. The impact of CGM-based diabetes education to change unhealthy living and eating habits on the blood glucose profile is still unclear.

Objective

Based on the retrospective results of CGM, outpatient education such as diet and exercise was applied to outpatients with type 2 diabetes mellitus (T2DM) who were managed by oral hypoglycemic drugs. This study aims to evaluate the effects on blood glucose profiles.

Methods

A total of 88 outpatient T2DM patients medicated with oral hypoglycemic drugs in the Department of Endocrinology, Nanjing First Hospital in 2021 were included and managed by CGM, involving 60 male and 28 female patients. The enrolled patients maintained the original hypoglycemic treatment regimen and lifestyle habits on the 1st to 3rd day. On the 4th day, we downloaded and analyzed CGM data and provided outpatient education based on individualized eating habit and exercise. On the 6th day, the CGM sensor and recorder were removed. CGM data on the 2nd day versus 5th day were compared for dynamic blood glucose profiles, including the 24 h mean blood glucose (MBG), mean amplitude of glycemic excursion (MAGE) and time in target glucose range (TIR) .

Results

Based on the CGM results, MBG in outpatients with T2DM on the 5th day after outpatient education was significantly reduced from (8.34±1.97) mmol/L to (7.85±1.65) mmol/L (P<0.05). TIR was significantly elevated from (78.21±24.64) % to (84.28±21.87) % (P<0.05). Moreover, MAGE was significantly reduced from (4.53±2.25) mmol/L to (3.80±1.80) mmol/L (P<0.05). Stratified by the course of T2DM, MBG after outpatient education significantly decreased in both patients with T2DM course <10 years (n=62) and those with T2DM course ≥10 years (n=26) than the baseline before education (P<0.05). After outpatient education, the standard deviation (SD), MAGE and target glucose range (TAR) were significantly reduced, while TIR was significantly elevated in patients with T2DM course <10 years (P<0.05). Stratified by age, MBG and TAR after outpatient education were significantly reduced in both patients aged <65 years old (n=55) and those aged ≥65 years old (n=33) than the baseline before education, while TIR was significantly elevated (P<0.05). SD and MAGE were significantly reduced after outpatient education in patients aged <65 years old (P<0.05) .

Conclusion

Based on CGM results, outpatient education such as diet and exercise could effectively improve MBG, TIR levels, and blood glucose variability in outpatient T2DM patients using oral hypoglycemic drugs. Patients with less than 10 years of T2DM course and younger than 65 years of age gain more clinical benefits.

Retrospective Study on the Efficacy of Qi Li Qiang Xin Jiao Nang in Reducing the Risk of Diuretic Resistance in Patients with Acute Decompensated Chronic Heart Failure

FENG Chao, JIANG Hantao, FAN Guanwei, LI Lan, FENG Jinping

2024, 27(21):  2578-2585.  DOI: 10.12114/j.issn.1007-9572.2023.0585

Asbtract ( )   HTML ( )   PDF (1709KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Diuretic resistance is associated with increased mortality in patients with heart failure (HF). Qi Li Qiang Xin Jiao Nang, a Traditional Chinese Medicine, are used in the treatment of HF. However, clinical evidence of their effectiveness in improving diuretic resistance is lacking.

Objective

To investigate whether Qi Li Qiang Xin Jiao Nang can reduce the risk of diuretic resistance and improve prognosis in patients with acute decompensated chronic heart failure (ADCHF) .

Methods

This study included 374 HF patients treated in the CICU ward of Tianjin University Chest Hospital from January 2018 to June 2022. Patients were divided into diuretic resistance (118 patients) and non-diuretic resistance groups (256 patients) based on the occurrence of diuretic resistance. Patient data and laboratory results were collected. A 12-month follow-up was conducted to observe rehospitalization due to cardiovascular events or all-cause mortality. Kaplan-Meyer survival curves were plotted for each group, and the Log-rank test was used for comparison. Multivariate Logistic regression analysis was performed to explore factors influencing diuretic resistance. Multivariable Cox regression analysis was used to explore factors affecting the occurrence of endpoint events in ADCHF patients.

Results

The diuretic resistance group showed higher age, body mass, NT-proBNP, blood urea nitrogen, creatinine, uric acid, and international normalized ratio (INR) but lower 24-hour fluid intake, estimated glomerular filtration rate (eGFR), lymphocyte count, and usage of Qi Li Qiang Xin Jiao Nang. Multivariate Logistic regression analysis indicated that the use of Qi Li Qiang Xin Jiao Nang (OR=0.363, 95%CI=0.186-0.708, P=0.003) and increased 24-hour fluid intake (OR=0.286, 95%CI=0.177-0.461, P<0.001) were protective factors against diuretic resistance in ADCHF patients. Increased body mass (OR=1.064, 95%CI=1.040-1.088, P<0.001) and elevated uric acid (OR=1.002, 95%CI=1.000-1.004, P=0.027) were risk factors. Log-rank test results showed that the average survival time without endpoint events was shorter in the diuretic resistance group (χ²=11.866, P=0.001) and in patients not using Qi Li Qiang Xin Jiao Nang (χ²=6.502, P=0.011). Multivariable Cox regression analysis revealed that the use of Qi Li Qiang Xin Jiao Nang (HR=0.536, 95%CI=0.308-0.933, P=0.027) and angiotensin receptor enkephalase inhibitors/angiotensin converting enzyme inhibitors/angiotensin receptor blockers (HR=0.435, 95%CI=0.229-0.826, P=0.011) were protective factors against endpoint events, while increased total bilirubin (HR=1.019, 95%CI=1.008-1.030, P=0.001) and total bile acids (HR=1.029, 95%CI=1.002-1.058, P=0.036) were risk factors.

Conclusion

The use of Qi Li Qiang Xin Jiao Nang in addition to standard HF treatment can reduce the risk of diuretic resistance in patients with ADCHF and decrease the risk of rehospitalization due to cardiovascular events or all-cause mortality within one year.

Body Composition Analysis of the Effect of Water Load Parameters on Prognosis of Patients with Different Modes of Dialysis: a Multicenter Prospective Cohort Study

ZHANG Dongliang, MA Yingchun, REN Jianwei, WANG Lei, ZHAO Jingxin, LIN Xuya

2024, 27(21):  2586-2591.  DOI: 10.12114/j.issn.1007-9572.2023.0309

Asbtract ( )   HTML ( )   PDF (1533KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Maintenance hemodialysis (MHD) and peritoneal dialysis (PD) are main treatment methods for uremic patients. It remains an important content of clinical research on better developing treatment protocols to address overhydration (OH) in dialysis patients, and the effect of applying body composition monitor (BCM) on the prognosis of dialysis patients treated with different dialysis models is still controversial.

Objective

To explore the relationship between OH parameters of BCM and prognosis in patients treated with MHD and PD.

Methods

From October 2017 to March 2022, 334 patients on maintenance dialysis in Beijing Jishuitan Hospital affiliated to Capital Medical Medical University, Beijing Boai Hospital, Aviation General Hospital, Beijing Changping District Hospital and Beijing Changping Hospital of Integrated Traditional Chinese and Western Medicine were included as the study objects and divided into MHD group (n=188) and PD group (n=146) according to their renal replacement therapy mode. The general data of and BCM related parameters were collected through the electronic medical record system. Patients included in the study were followed up, dialysis treatment parameters, body weight, systolic blood pressure and diastolic blood pressure were recorded, and the average of multiple follow-up results were calculated. Endpoint events were recorded during follow-up period, with the primary endpoint event as all-cause death (ACM), secondary endpoint events as cardiovascular events (CVE), combined adverse events (CAE), surgery or fracture (SOF). Spearman rank correlation analysis was used to explore the correlation between endpoint events and BCM parameters, and stepwise multiple Logistic regression analysis was used to explore the influencing factors of secondary endpoint events in patients. The ACM survival curve was plotted by Kaplan-Meier method, and the difference of survival curve between the two groups was compared by Log-rank test. Multivariate Cox regression analysis was used to explore the influencing factors of ACM.

Results

A total of 311 patients completed follow-up, with a median follow-up time of 29.9 (18.0, 36.0) months, including 176 patients in MHD group and 135 patients in PD group. Dialysis age, body weight, target body weight, adipose tissue content and adipose tissue index in MHD group were higher than those in PD group, and OH was lower than that in PD group (P<0.05). The mean values of body weight, target body weight, systolic blood pressure, adipose tissue content and adipose tissue index in MHD group were higher than those in PD group, while the mean value of OH, standard deviation of OH (OHsd), maximum change value of OH (OHd) and maximum change value of OH in MHD group were lower than those in the PD group (P<0.05). The incidence of CVE, CAE and SOF was 16.5% (29/176), 39.2% (69/176) and 4.0% (7/176) in the MHD group, and 45.9% (62/135), 83.0% (112/135) and 8.2% (11/135) in PD group, respectively. The incidence of CVE and CAE in MHD group was significantly lower than PD group (χ²=32.009, P<0.001; χ²=60.132, P<0.001). Multivariate Logistic regression analysis showed that the ratio of mean value of extracellular water to mean value of intracellular water in MHD group (OR=57.974, 95%CI=1.393-2 413.247) was the influencing factor of CVE, OHd (OR=1.255, 95%CI=1.076-1.462) was the influencing factor of CAE (P<0.05). The age of patients in PD group (OR=1.029, 95%CI=1.008-1.052) was the influencing factor of CVE (P<0.05), and OHd (OR=1.962, 95%CI=1.355-2.842) was the influencing factor of CAE (P<0.05). Kaplan-Meier survival curve of ACM between the two groups showed that the incidence of ACM in PD group was higher than that in MHD group (χ²=7.145, P=0.008). Multivariate Cox regression analysis showed that age (HR=1.070, 95%CI=1.019-1.123) was the influencing factor of ACM in MHD group (P<0.05), DBPm (HR=0.942, 95%CI=0.854-0.992) and OHsd (HR=3.612, 95%CI=2.072-6.296) were the influencing factors of ACM in PD group (P<0.05) .

Conclusion

The incidence of primary endpoint event and secondary endpoint events in PD group was higher than that in MHD patients, and OH was more obvious in PD patients than MHD patients. The fluctuation of OH value obtained by BCM could predict ACM in PD patients.

Application of Captopril Challenge Test in Diagnosis, Classification and Clinical Outcomes of Primary Aldosteronism

TAN Lu, CHEN Tao, GAO Hongjiao, CHEN Yanxi, REN Yan

2024, 27(21):  2592-2599.  DOI: 10.12114/j.issn.1007-9572.2023.0839

Asbtract ( )   HTML ( )   PDF (1733KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Primary hyperaldosteronism (PA) has been recommended by numerous hypertension guidelines to expand screening, early diagnosis and treatment, as a secondary hypertension disease with the highest incidence, great cardiovascular and cerebrovascular dangers but high cure rate after surgery. However, the diagnosis, classification and clinical outcomes evaluation of these patients are varied and controversial. Captopril challenge test (CCT) is expected to provide whole-course management for PA patients because it is convenient, safe and can be used directly in the community or outpatient clinic.

Objective

To explore the diagnostic efficacy, classification and biochemical remission assessment of CCT in patients with PA.

Methods

The study population consisted of 824 patients who completed the cause screening for hypertension and were enrolled in the Department of Endocrinology and Metabolism, West China Hospital, Sichuan University from October 1 th 2020 to December 30 th 2022. After screening, 247 patients with PA and 123 patients with essential hypertension (EH) were enrolled, and PA was classified into aldosterone-producing adenoma (APA, 81 patients), idiopathic hyperaldosteronism (IHA, 55 patients), and uncategorized PA (u-PA, 111 patients). The differences among the four groups were compared and the receiver operating characteristic (ROC) curve analysis showed the diagnostic performance for the prediction of PA. Secondly, the ROC curves of each post-CCT index for APA and IHA respectively were plotted. Finally, according to the postoperative clinical outcomes, the patients with unilateral adrenal resection were divided into three groups: clinical remission, clinical improvement, and no remission group. The difference between the three groups was compared, and the cut-off point of biochemical remission of CCT in APA patients was analyzed.

Results

The post-CCT plasma aldosterone concentration (PAC) level had the highest diagnostic efficiency for PA (AUC=0.921, 95%CI=0.893-0.950), and the cut-off was 11.7 ng/dL. The sensitivity and specificity respectively was 84.6% and 86.0%. The post-CCT aldosterone to renin ratio (ARR) also had a good diagnostic efficacy for PA (AUC=0.868, 95%CI=0.823-0.923). The cut-off was 2.8 (ng/dL) / (mU/L), and the sensitivity and specificity respectively were 82.2% and 81.0%. The post-CCT PAC>17 ng/dL can assist in the diagnosis of APA subtypes. When post-CCT PAC<11.7 ng/dL combined with post-CCT ARR< 2.8 (ng/dL) / (mU/L), APA was almost excluded. The inhibition rate of PAC after CCT and the PAC remission rate after surgery were less effective in judging the biochemical remission assessment of APA, and post-CCT PAC<11.7 ng/dL or post-CCT ARR<2.8 (ng/dL) / (mU/L) could better. Among the patients receiving surgical treatment, 87.2% had post-CCT PAC<11.7 ng/dL, and 89.7% had post-CCT ARR<2.8 (ng/dL) / (mU/L), which was close to the postoperative clinical remission level (88.0%) .

Conclusion

CCT can be used throughout the diagnosis, classification and clinical outcomes evaluation of PA patients. post-CCT PAC 11.7 ng/dL and post-CCT ARR 2.8 (ng/dL) / (mU/L) are good cut-off for the diagnosis, and can also be used for the classification of APA and the judgment of postoperative biochemical remission. Secondly, detection before CCT has little clinical significance and can simplify the process.

Construction of a Comprehensive Health Management Program for Elderly Postoperative Colorectal Cancer Patients

ZHOU Jin, WANG Yan, WANG Hui, ZHANG Yinan, ZHI Xiaoxu, ZHANG Zhiyuan, XU Dejing, ZHOU Xin, ZHANG Liuliu

2024, 27(21):  2600-2606.  DOI: 10.12114/j.issn.1007-9572.2023.0706

Asbtract ( )   HTML ( )   PDF (1669KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The elderly colorectal cancer population has a high prevalence and complex condition, and postoperative rehabilitation faces various challenges. It is of great significance to construct a scientific, practical and comprehensive postoperative health management program for colorectal cancer in the elderly to improve patients' health.

Objective

To construct a comprehensive health management program for elderly postoperative colorectal cancer patients, and provide reference for postoperative rehabilitation of elderly colorectal cancer patients.

Methods

Based on literature review and qualitative interviews, the management program for elderly postoperative colorectal cancer patients was initially formulated. The Delphi method was used to conduct 2 rounds of correspondence with 16 experts from tertiary hospitals in Nanjing and Shanghai. The motivation degree of the experts was evaluated based on questionnaire recovery rate and text revision rate. Furthermore, the authority coefficient was used to evaluate the degree of expert authority, while the coefficient of variation and Kendall's W coefficient were used to evaluate the coordination of expert opinions. Based on opinions and discussion of experts, the ultimate formation of the health management program for elderly postoperative colorectal cancer patients was constructed after adjusting the content of entries.

Results

The recovery rates of the two rounds of expert correspondence were 94.12% and 100.00%, respectively. The text revision rates were 56.25%, and the authority coefficient was 0.91. The mean importance scores of items in the two rounds of the consultation ranged from 3.81 to 5.00 and 4.13 to 5.00, with the coefficients of variation from 0 to 0.24 and 0 to 0.20. The Kendall's W coefficients of expert opinions were 0.211 and 0.222, respectively (P<0.001), with an improvement observed in the second round compared to the first round. After two rounds of expert correspondence and the expert group discussion, the final management program for elderly postoperative colorectal cancer patients was determined, including 9 primary items (team building, psychological support, physical activity, stoma care, nutritional intervention, TCM rehabilitation techniques, peer education, treatment and follow-up, self-management) and 39 secondary items.

Conclusion

The health management program constructed in this study for elderly postoperative colorectal cancer patients is scientific, reliable, applicable and practical, and can provide guidance for rehabilitation of elderly patients after colorectal cancer surgery.

Mediating Effect of Self-regulatory Fatigue and Moderating Effect of Health Literacy in the Relationship between Occupational Stress and Mental Health in Lawyers

HAN Huanxia, FAN Chunlei, WANG Ligang, TAO Ting, GAO Wenbin

2024, 27(21):  2607-2616.  DOI: 10.12114/j.issn.1007-9572.2023.0039

Asbtract ( )   HTML ( )   PDF (1961KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Lawyer is one of the most stressful jobs, but lawyers' occupational stress is rather under-researched in China. Previous studies have shown that occupational stress and mental health are related to self-regulatory fatigue and health literacy in lawyers, but there is a lack of research on their interaction mechanism.

Objective

To explore the association of occupational stress and mental health in lawyers and the internal mechanism of action of self-regulatory fatigue and health literacy between them.

Methods

A convenience sample of 660 lawyers from 7 leading Chinese law firms were surveyed from May to June 2022 using questionnaires including a self-compiled Demographic Questionnaire, the Lawyers' Occupational Stress Scale, Symptom Checklist-90 (SCL-90), Self-regulatory Fatigue Scale (SRF-S) and National Residents' Health Literacy Surveillance Rapid Assessment Questionnaire (HLSRAQ). Stepwise regression was used to explore the mediating effect of self-regulatory fatigue between occupational stress and mental health, and bootstrap method was used to test the mediating effect of self-regulatory fatigue. Model 5 in PROCESS 3.4 was used to explore the moderated mediating effect of health literacy between occupational stress and mental health. Bootstrap method was used to test the moderating mediating effect of health literacy, and further simple slope test was used to test the moderating effect, and the effects of occupational stress on the mental health of lawyers with different health literacy levels were analyzed.

Results

Six hundred and fifty-six cases (99.39%) who effectively responded to the survey were included for final analysis. The average scores of occupational stress, SCL-90, SRF-S and HLSRAQ were (106.9±34.8), 39.0 (15.0, 84.0), (39.4±10.0) and (13.9±3.7), respectively. Stepwise regression analysis showed that occupational stress could positively predict mental health (β=0.36, t=13.40, P<0.01). Self-regulatory fatigue also had a significant positive predictive effect on mental health (β=0.55, t=20.32, P<0.01). Bootstrap analysis showed that 95%CI of the total effect, indirect effect and direct effect of occupational stress on mental health did not include 0 (P<0.01). The moderated mediating effect analysis showed that the product of occupational stress and health literacy had a significant predictive effect on mental health (β=-0.02, t=-2.00, P<0.05). The Bootstrap method showed that the 95%CI of the indirect effect of lawyer occupational stress on mental health did not include 0 (P<0.01). Simple slope test showed that the association between them was found to be statistically significant regardless of being moderated by different levels of health literacy (P<0.01), and the predictive effect of occupational stress showed a downward trend with the improvement of health literacy level (P<0.01) .

Conclusion

Occupational stress influenced mental health in lawyers medicated by self-regulatory fatigue with health literacy as a moderator.

Antagonistic Effect of Salidroside on Podocyte Pyroptosis in Diabetic Kidney Disease Rats under Hypoxia Based on NLRP3/IL-1β/TGF-β1 Pathway

LI Jiawu, QIN Feng, SONG Shengqin, ZHAI Tin, XIN Hongyun, BA Yinggui

2024, 27(21):  2617-2622.  DOI: 10.12114/j.issn.1007-9572.2023.0678

Asbtract ( )   HTML ( )   PDF (1716KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Salidroside has been shown to protect diabetic kidney disease (DKD) rats, however, whether it is equally effective in a hypoxic environment and the specific mechanism of action remain unclear.

Objective

To observe the effects of salidroside on biochemical parameters, renal tissue pathological lesion, and the expression of cell pyroptosis-related proteins in a rat model of DKD under hypoxia, and explore its mechanisms of action.

Methods

From March 2022 to March 2023, forty 6-week-old SPF-grade SD male rats were used, with eight randomly selected as the control group, the remaining were modeled. Twenty-four DKD model rats were randomly divided into three groups of the model group, salidroside group, and salidroside+nod-like receptor protein 3 (NLRP3) activator group for intervention, with 8 in each group. After the intervention, blood was collected from the abdominal aorta for biochemical parameter testing, hematoxylin-eosin (HE) staining, and transmission electron microscopy were used to observe renal pathological changes. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of interleukin (IL) 1β and IL-18. Western blotting was used to measure the expression levels of Caspase-1, Gasdermin D (GSDMD), NLRP3, and transforming growth factor β1 (TGF-β1) in renal tissue.

Results

The body weight of the rats after modeling was significantly lower than that of the control group (P<0.05). Compared to the control group, the levels of triglyceride (TG), total cholesterol (TC), fasting blood glucose (FBG), urinary microalbumin (UMA), blood urea nitrogen (BUN), and serum creatinine (Scr) were significantly higher in the model group (P<0.05). Compared to the model group, the BUN, UMA, and Scr levels were significantly lower in the salidroside group (P<0.05). Compared to the salidroside group, the UMA, BUN, and Scr levels were significantly higher in the salidroside+NLRP3 activator group (P<0.05). HE staining and transmission electron microscopy revealed that renal tissue pathological changes in the salidroside group were significantly reduced than the model group, and aggravated in the salidroside+NLRP3 activator group. Compared to the control group, serum IL-1β and IL-18 levels were significantly higher in the model group (P<0.05) ; these levels were significantly lower in the salidroside group compared to the model group (P<0.05), and higher in the salidroside+NLRP3 activator group compared to the salidroside group (P<0.05). Compared to the control group, the expression of Caspase-1, GSDMD, NLRP3, and TGF-β1 proteins was significantly higher in the model group (P<0.05) ; it was significantly lower in the salidroside group compared to the model group (P<0.05), and higher in the salidroside+NLRP3 activator group compared to the salidroside group (P<0.05) .

Conclusion

Salidroside exerted therapeutic effects on DKD rats in a hypoxic environment without reducing blood glucose and lipid levels, this effect may be related to the inhibition of NLRP3, affecting the NLRP3/IL-1β/TGF-β1 signaling pathway, ultimately improving podocyte pyroptosis injury.

Original Research·Thyroid Disease Section

Study on the Traditional Chinese Medicine Syndrome Characteristics of Cancer-related Fatigue and Their Correlation with Thyroid Function Level

GU Shanshan, XU Yun, FU Li, WANG Jinghui, GUO Xingyu

2024, 27(21):  2623-2629.  DOI: 10.12114/j.issn.1007-9572.2023.0691

Asbtract ( )   HTML ( )   PDF (1997KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

The integration of Traditional Chinese Medicine (TCM) and Western Medicine in a multidisciplinary approach is the future direction for the diagnosis and treatment of Cancer-Related Fatigue (CRF). However, the lack of standard criteria for syndrome differentiation and treatment selection limits the application of TCM in Western and international contexts. Patients with CRF often experience fatigue associated with metabolic and energy balance abnormalities, with thyroid function playing a critical role in the body's energy metabolism and regulation.

Objective

To analyze the TCM syndrome characteristics of CRF and explore their correlation with thyroid function levels, providing a reference for the integrated diagnosis and treatment of CRF and mechanism research in both TCM and western medicine.

Methods

The study included cancer patients who visited the oncology outpatient and inpatient departments of the China Academy of Chinese Medical Sciences Xiyuan Hospital in 2021. General information of the patients was collected. The Chinese version of the Revised Piper Fatigue Scale (RPFS-CV) was used to assess patients' fatigue. Thyroid function tests, including triiodothyronine (T₃), thyroxine (T₄), free triiodothyronine (FT₃), free thyroxine (FT₄), thyroid-stimulating hormone, anti-thyroid peroxidase antibody (TPO-Ab), and thyroglobulin antibody, were collected on the day of or the day after enrollment. TCM syndrome characteristics of CRF patients were collected through a self-designed CRF TCM Four-Diagnostic Information Form. Spearman's rank correlation analysis was used to explore the correlation between RPFS-CV fatigue scores and thyroid function indicators. Point biserial correlation analysis was used to investigate the correlation between RPFS-CV fatigue scores, thyroid function indicators, and TCM syndrome characteristics of CRF.

Results

A total of 159 CRF patients were included. The most common types of cancer were lung cancer (50 cases, 31.4%), breast cancer (23 cases, 14.5%), head and neck tumors (21 cases, 13.2%), rectal cancer (21 cases, 13.2%), and colon cancer (18 cases, 11.3%). The median diagnosis duration was 2.15 (3.16) years; 88 patients (55.3%) experienced recurrence or metastasis, with 40 patients (45.5%) having local recurrence and 38 patients (43.2%) having oligometastasis. The median duration of metastasis was 1.50 (2.83) years; 91 patients (57.2%) were in advanced stages, 101 patients (63.5%) had received antitumor treatment, and 57 patients (35.8%) had undergone chemotherapy. In TCM syndromes, deficiency syndromes with a frequency over 10% were Qi deficiency, heart deficiency, and spleen deficiency; among excess syndromes, those occurring more than 20 times were Qi stagnation and damp-cold. Syndromes with a median RPFS-CV fatigue score over 4 were, in descending order, damp-cold, Qi stagnation, spleen deficiency, heart deficiency, liver deficiency, damp-heat, and Qi deficiency. RPFS-CV fatigue scores were positively correlated with Qi deficiency, spleen deficiency, heart deficiency, liver deficiency, damp-cold, and Qi stagnation (P<0.05). RPFS-CV fatigue scores were negatively correlated with FT₃ and T₃ (P<0.05). Qi deficiency was positively correlated with T₄, Kidney deficiency with TPO-Ab, and Qi stagnation with FT₄ (P<0.05) ; Damp-heat was negatively correlated with T₃ and T₄ (P<0.05) .

Conclusion

The fatigue condition of CRF patients is closely related to TCM syndrome characteristics and thyroid function levels. Further research will help deepen the understanding of these correlations and promote the collaborative development of TCM and western medicine in the management of CRF disease.

Study on the Distribution of Clinical Symptoms and Syndromes of Hashimoto's Thyroiditis Complicated with Thyrotoxicosis

GE Yaxue, DING Zhiguo, CHEN Xiaoheng, LI Huilong, QI Shuo, HU Rui

2024, 27(21):  2630-2638.  DOI: 10.12114/j.issn.1007-9572.2023.0599

Asbtract ( )   HTML ( )   PDF (2111KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Traditional Chinese Medicine (TCM) has a systematic understanding of the occurrence, development, diagnosis and treatment of Hashimoto's thyroiditis complicated with thyrotoxicosis. However, at present, there are few studies on the clinical symptoms and syndrome distribution of TCM in this disease population, and there is also a lack of description of the syndrome distribution and syndrome diagnostic criteria of this disease in the national industry standards.

Objective

Using factor analysis combine with cluster analysis to explore the distribution of clinical symptoms and syndromes of Hashimoto's thyroiditis complicated with thyrotoxicosis, provide a basis for clinical syndrome differentiation and promote the standardization of Hashimoto's thyroiditis complicated with thyrotoxicosis syndrome.

Methods

From December 2020 to December 2021, 171 patients with Hashimoto's thyroiditis complicated with thyrotoxicosis who met the diagnostic criteria in the outpatient department of thyroid disease of Dongcheng District, Tongzhou District of Dongzhimen Hospital, Beijing University of Chinese Medicine and Sunsimiao Hospital was collected. The symptoms, signs, tongue, pulse and other four diagnostic information were collected by using the four diagnostic information collection table of Hashimoto's thyroiditis complicated with thyrotoxicosis'. Based on factor analysis and cluster analysis, the symptoms and syndrome distribution of Hashimoto's thyroiditis complicated with thyrotoxicosis were studied.

Results

Among the 171 patients with Hashimoto's thyroiditis complicated with thyrotoxicosis, there were 17 males and 154 females, with an average age of (39.98±13.30) years. Patients aged 20-60 years accounted for 87.72%. The symptoms with high frequency in the distribution of symptoms were fatigue, palpitation, irritability or impatience. Signs were swelling of the neck, finger tremor. The tongue image with higher frequency had red, thin tongue and tooth marks on the tongue. The moss were white and thin. The pulse condition were pulse string and pulse number. Factor analysis of 82 four diagnostic items of the questionnaire was collected, and 25 common factors were extracted. The cumulative variance contribution rate was 70.562%, and 62 meaningful symptoms were screened out. The 25 common factor results obtained by factor analysis were used as variables to perform R-type system cluster analysis, and a total of 5 types of syndrome types were obtained, namely: pattern of phlegm congealing due to liver depression, pattern of yin deficiency with effulgent fire, pattern of yang deficiency in spleen and kidney, pattern of qi stagnation due to liver depression, pattern of dual deficiency of qi and nutrient phases.

Conclusion

The basic TCM syndromes of Hashimoto's thyroiditis complicated with thyrotoxicosis can be divided into pattern of phlegm congealing due to liver depression, pattern of yin deficiency with effulgent fire, pattern of yang deficiency in spleen and kidney, pattern of qi stagnation due to liver depression, pattern of dual deficiency of qi and nutrient phases.

EZH2 Expression in B Cell Lymphocyte Subsets of Hashimoto's Thyroiditis and the Therapeutic Mechanism and Effect of Its Inhibitors

YI Shengguo, CAO Yedi, ZHAO Xue, LU Guizhi, ZHANG Yang, CONG Tiechuan, ZHANG Lanbo, ZHANG Jixin, LIANG Zhenwei, QU Chenxue, ZHANG Junqing, GAO Ying

2024, 27(21):  2639-2645.  DOI: 10.12114/j.issn.1007-9572.2023.0623

Asbtract ( )   HTML ( )   PDF (2111KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Thyroid autoantibody is a marker for the diagnosis of Hashimoto's thyroiditis (HT), and B cells are essential in the pathogenesis of HT. Enhancer of Zeste homolog 2 (EZH2), which is an important epigenetic regulator, plays an important role in the regulation of lymphocytes development and function.

Objective

To investigate EZH2 expression in plasmoblasts and plasma cells in HT, and further explore the therapeutic effect of EZH2 inhibitors in experimental autoimmune thyroiditis (EAT) model.

Methods

The thyroid tissues from 6 patients who underwent thyroidectomy (3 HT patients with PTC, 3 patients with PTC alone) in Peking University First Hospital between 2010 and 2020 were obtained from the contralateral lobe with thyroid cancer, and screened for the expression of B-lymphocyte-related genes by RNA-seq; thyroid tissues from 16 HT patients and 8 normal thyroid tissues were collected and verified for the the expression of EZH2 in B cells in HT thyroid tissues by immunohistochemistry or immunofluorescence, respectively. Fine-needle aspiration (FNA) samples from patients with HT (n=25), and peripheral blood from patients with HT (n=19) or healthy donors (n=12) were analyzed by flow cytometry to define altered EZH2 expression in plasmablasts and plasma cells. Fifteen seven-week-old NOD.H-2^h4 mice were randomly divided into the control (n=5), EAT without injection group (n=5), and EZH2 inhibitor+ GSK126 injection group (10 mg/kg, intraperitoneal injection 3 times /week, n=5). The degree of thyroid inflammation and changes in TgAb levels were observed after 8 weeks.

Results

RNA sequencing analysis showed that EZH2 and genes associated with the B-cell phenotype such as CD19, CD27, CD38, CD52 were higher expressed in HT hyroid tissues compared with normal thyroid tissues. Immunohistochemical results showed that immunohistochemical staining for EZH2 in 16 HT thyroid tissue specimens was strongly positive with positive cells observed in the GC region, and no positive cells were observed in the staining of 8 normal thyroid tissues. EZH2 staining in HT thyroid tissue was highly expressed in the GC region, and EZH2 was specifically expressed in CD₁₉⁺ B cells. The results of flow cytometry assay showed that the proportion of CD₁₉⁺ B cells, plasmablasts and plasma cells in HT FNA samples was higher than that of HD peripheral blood and HT peripheral blood samples (P<0.01), and the proportion of EZH2 positivity in CD₁₉⁺ B cells and plasma cells was higher in HT FNA samples than that of HT peripheral blood (P<0.005). In the mouse experiments, lymphocytic infiltration of the thyroid tissues was increased in the EAT group compared to the control group. In the GSK126 treatment groups, the thyroid inflammatory score and serum TgAb titer were significantly higher than the control group and lower than the EAT group.

Conclusion

EZH2 over-expression in CD₁₉⁺ B cells of HT hyroid tissues may promote the differentiation of B cells into plasma cells and auto-antibody production, which leads to the destruction of thyroid tissues. EZH2 inhibitors can slow down the degree of thyroid inflammation in the EAT model. Increased EZH2 expression in plasmablasts may be involved in the pathogenesis of HT. EZH2 may serve as a therapeutic target for HT, although further studies are needed.

Original Research·Health Social Worker Section

Intervention Space and Realistic Challenge of Medical Social Workers in Discharge Preparation Work

SUN Zhenjun, ZHU Huimin

2024, 27(21):  2651-2656.  DOI: 10.12114/j.issn.1007-9572.2023.0620

Asbtract ( )   HTML ( )   PDF (1758KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

Discharge preparation can help patients smoothly transition from one health care environment to another. In the medical institutions of foreign countries, discharge preparation is one of the main responsibilities of medical social workers. However, in China, there is currently relatively little involvement of social workers in discharge preparation.

Objective

To understand the intervention space and realistic challenges faced by medical social workers in the field of discharge preparation, and provide reference basis for improving social work in discharge preparation.

Methods

Using purposive sampling method from March to June 2023, based on a multidisciplinary perspective, adopt the qualitative interview method to conduct in-depth interviews with 20 medical personnel (including doctors, nurses, medical social workers, and medical management personnel). The interview data is organized and analyzed using Nvivo 12.0 software and the Colaizzi seven step analysis method.

Results

Medical social workers mainly carry out psychological and social assessments, develop professional service plans, provide social work interventions, and conduct follow-up in the field of discharge preparation services. While accumulating some local practical experience, they also face many realistic challenges, including insufficient access to social resources, multiple obstacles to the linkage between hospital and community, the lack of a standardized mechanism, inadequate interdisciplinary collaboration, a shortage of human resources for social workers, the need to improve their comprehensive abilities.

Conclusion

Promote the development of social work services for discharge preparation in China, by advocating for the construction of the social policy system and mechanism, building a multidisciplinary cooperation platform for hospitals, promoting the comprehensive capacity building of medical social workers.

A Study on the Typologies of Embedded Development of Medical Social Work in the Context of Government Purchasing Services: Views of Medical Social Workers in 15 Public Hospitals in Shenzhen

LEI Jie, OU Mengyu, LIN Liang

2024, 27(21):  2657-2664.  DOI: 10.12114/j.issn.1007-9572.2023.0671

Asbtract ( )   HTML ( )   PDF (2000KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Background

As the medical service model in China transitions from unidirectional treatment to holistic health, medical social work, aimed at helping individuals help themselves, has gained more opportunities to integrate into the hospital setting.

Objective

This paper aims to explore the embedding paths, strategies, and outcomes of medical social work in the hospital setting, to categorize the types of integrative development in medical social work, and to provide significant insights for the robust development of medical social work within the healthcare system.

Methods

Based on Granovetter's embeddedness theory, purposive sampling was employed to conduct in-depth interviews with 33 medical social workers from 15 public hospitals in Shenzhen, where services were purchased by the government. Data analysis was performed using thematic analysis with the aid of Nvivo12.0 software.

Results

In the context of government-purchased services, the embedding paths of medical social work include structural embedding and relational embedding. The main embedding strategies are "indirect compliance" and "passive compromise" under structural embedding, and "mutual benefit" and "self-empowerment" under relational embedding. The embedding outcomes also led to two different impacts: "administrative" and "professional".

Conclusion

The study suggests that the integrative development of medical social work can be categorized into four types: "superficial embedding" "administration-led" "mutual development" and "professional inter-construction".

Review & Perspectives

Research Progress on the Role of Gut Microbiota in the Pathogenesis and Treatment of Sepsis-associated Liver Injury

CHEN Wensheng, LIU Wenming

2024, 27(21):  2665-2671.  DOI: 10.12114/j.issn.1007-9572.2023.0069

Asbtract ( )   HTML ( )   PDF (1928KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Sepsis is characterized by a dysregulation of immune response to infection, leading to life-threatening organ dysfunction. Sepsis-associated liver injury (SALI) is considered an independent risk factor for predicting death in the intensive care unit (ICU). With the increasing number of studies on the gut-liver axis in recent years, the close linkage of gut microbiota and liver diseases has been gradually revealed. Dysbiosis of gut microbiota has been shown to induce SALI through the mitogen-activated protein kinase/nuclear transcription factorκB (MAPK/NF-κB) signaling pathway and damage to the intestinal barrier. Meanwhile, fecal microbiota transplantation (FMT) and the application of probiotics have great potential in the treatment of SALI. This paper reviews the relevant research progress in recent years both at home and abroad, in order to provide new insights into the pathogenesis and treatment of SALI.

Recent Advances in Diet and Exercise Interventions towards Craniopharyngioma-related Hypothalamic Obesity

REN Ying, WANG Chaohu, ZHANG Nannan, BAO Yun, QI Songtao, DENG Yingying

2024, 27(21):  2672-2678.  DOI: 10.12114/j.issn.1007-9572.2022.0725

Asbtract ( )   HTML ( )   PDF (1972KB) ( )  

Figures and Tables | References | Related Articles | Metrics

Craniopharyngioma-related hypothalamic obesity (CHO) has become a key issue in postoperative management of craniopharyngioma. Modified low calorie diet and exercise interventions have been found by some studies to be effective in relieving CHO, and suggested to be used as non-pharmacological treatments for weight management of craniopharyngioma patients. However, there are few relevant studies in China. We reviewed the latest developments in prevalence, hazards and risk factors as well as diet and exercise interventions towards CHO, in order to improve the outcomes and quality of life of CHO patients. In addition, we put forward recommendations on comprehensively improving the quality of life of CHO patients, such as making efforts to value CHO clinically, carrying out prospective studies on weight control in CHO, and developing rigorous diet and exercise interventions.

Advances in Endoplasmic Reticulum Stress in Liver Diseases

LI Chuan, WU Yunchong, YANG Yanyan, LU Tao, LIU Yujuan, LIN Shide

2024, 27(21):  2679-2684.  DOI: 10.12114/j.issn.1007-9572.2023.0545

Asbtract ( )   HTML ( )   PDF (1895KB) ( )  

Figures and Tables | References | Related Articles | Metrics

A large number of studies have confirmed that endoplasmic reticulum stress (ERS) is closely related to the development and progression of liver diseases, but the mechanism of the association between ERS and liver disease progression has not been clarified and needs to be further explored. Numerous studies have found that moderate ERS can activate the unfolded protein response (UPR) to protect cells, while severe or persistent ERS can induce apoptosis. Therefore, exploring the role of ERS in the pathogenesis of liver diseases may help to discover new therapeutic strategies. This paper describes the current research status and potential therapeutic strategies of ERS and UPR in various liver diseases.