Table of Content

20 August 2024, Volume 27 Issue 24

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Guidelines·Consensus

Chinese Expert Consensus on the Diagnosis and Treatment of Binge Eating Disorder

Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, PENG Sufang, HE Qianqian, LIU Qiang, CHEN Yan, ZHANG Lan, LI Xueni, QIAO Huifen, KONG Qingmei, KUANG Guifang, CHEN Han, YU Yang, JIANG Jingjing, LIU Lanying, ZHANG Darong, LI Keqing, WANG Zhen, CHEN Jue

2024, 27(24):  2941-2953.  DOI: 10.12114/j.issn.1007-9572.2024.0030

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Binge-eating disorder (BED) is a type of eating disorder characterized by recurrent episodes of binge eating. Patients with BED have recurrent impulsive and out-of-controlled binge eating behavior, which can lead to gastrointestinal disorders, obesity, and the resulting metabolic and functional disorders of various systems and other physical problems; and it is also often co-morbid with affective disorder, anxiety disorders, substance use disorders, and other mental disorders, which need to be taken seriously. However, the recognition of BED in China was late, and it is difficult to achieve early identification and diagnosis, resulting in a prolonged course of disease. Therefore, under the organization of the Eating Disorders Coordination Group of the Psychosomatic Medicine Society of the Chinese Medical Association, together with the Eating Disorders Research Collaboration Group of the Psychiatric Medicine Society of the Chinese Medical Association, an expert group composed of 15 psychiatrists and evidence-based medicine experts, and 2 internal medicine experts, formulated this expert consensus based on evidence-based medical evidence, domestic and foreign guidelines and expert consensus, and expert experiences. The aim of this study is to improve the recognition, diagnosis and treatment of BED by psychiatrists, internists and general practitioners in China.

Original Research

Correlation Study between Hyperuricemia and Chronic Pulmonary Heart Disease: Based on LASSO Regression and Propensity Score Matching

QI Haiyan, WANG Jie, LUO Yuxi, WU Yun

2024, 27(24):  2954-2960.  DOI: 10.12114/j.issn.1007-9572.2023.0793

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Background

In recent years, numerous studies have indicated that hyperuricemia (HUA) is a contributing factor to certain diseases. However, whether HUA is a contributing factor to chronic pulmonary heart disease (CPHD) still requires further investigation.

Objective

To explore the association between HUA and CPHD, aiming to provide a theoretical basis for the management of serum uric acid (SUA) levels in patients with CPHD.

Methods

A total of1 171 patients with chronic obstructive pulmonary disease (COPD) admitted to the First Affiliated Hospital of Xinjiang Medical University from 2019 to 2023 were included in the study. They were divided into a CPHD group (470 cases) and a COPD group (701 cases) based on whether they had CPHD. General information, laboratory test results, and echocardiographic findings of the patients were collected. LASSO regression was used to select variables, and propensity score matching (PSM) was employed to eliminate the influence of confounding factors. Multivariate Logistic regression analysis was conducted to explore the influencing factors of CPHD in COPD patients.

Results

The CPHD group had lower proportions of females, Han ethnicity, smokers, drinkers, idiopathic pulmonary fibrosis, chronic bronchitis, bronchial asthma, lymphocyte percentage, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, cardiac output, left ventricular ejection fraction compared to the COPD group. Higher proportions of heart function class 3-4, HUA, pulmonary embolism, congenital heart disease, red blood cell count, neutrophil percentage, SUA, blood urea nitrogen, D-dimer, N-terminal pro-B-type natriuretic peptide, right atrial diameter, right ventricular diameter, left atrial diameter, right ventricular outflow tract diameter, and pulmonary artery diameter were observed in the CPHD group, with statistically significant differences (P<0.05). After variable selection by LASSO regression and PSM, 469 cases were included in both the COPD and CPHD groups. After matching, the CPHD group had higher proportions of heart function class 3-4, HUA, right atrial diameter, right ventricular diameter, right ventricular outflow tract diameter, and pulmonary artery diameter, while lower proportions of bronchial asthma and lymphocyte percentage compared to the COPD group, with statistically significant differences (P<0.05). Multivariate Logistic regression analysis showed that increased HUA, heart function class 3-4, right atrial diameter, right ventricular diameter, and pulmonary artery diameter were risk factors for CPHD in COPD patients (P<0.05), while having bronchial asthma and increased left ventricular end-diastolic diameter were protective factors for CPHD in COPD patients (P<0.05). SUA levels were stratified by quartiles, and multivariate Logistic regression analysis showed that compared to Q1 (SUA<237.31 μmol/L), patients in Q4 (SUA>381.29 μmol/L) had a 1.421-fold inScrsed risk of having CPHD.

Conclusion

HUA is a contributing factor to the occurrence and development of CPHD. Actively controlling SUA levels may help prevent the occurrence and development of CPHD.

Variations and Clinical Significance of Sleep Monitoring Indicators among Healthy Adults of Different Ages and Genders in Various Altitudes

YANG Linglin, CHEN Yujie, WANG Yi, LI Yong

2024, 27(24):  2961-2968.  DOI: 10.12114/j.issn.1007-9572.2023.0538

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Background

Sleep disturbances are the most common health issues in high-altitude environments. Current research on the sleep architecture of healthy populations is limited to the same altitude and involves a small number of subjects, lacking sufficient reliability.

Objective

This study aims to analyze the differences in sleep monitoring indicators among healthy adults of different ages and genders across various altitudes, exploring the impact of altitude, age, and gender interactions on these indicators.

Methods

Healthy volunteers recruited from the plains of Chengdu, Sichuan Province, and the plateau area of Kunming, Yunnan Province, from January 2020 to September 2022 were selected as study subjects. Volunteers' gender, height, body mass, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were collected. Total sleep time (TST), sleep efficiency, and sleep parameters [percentage of stage N1 (N1%), stage N2 (N2%), stage N3 (N3%) of non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep in total sleep time] were recorded. Age was categorized into two groups (20-39 and 40-60 years) for a two-way ANOVA to explore the effects of age, gender, and altitude on sleep parameters.

Result

A total of 91 people were recruited in low-altitude areas, including 48 men and 43 women. A total of 90 people were recruited for the high-altitude area, including 46 men and 44 women. In females, TST was higher in high-altitude areas compared to low-altitude areas (P<0.05). In both males and females, N1% was higher and N2% was lower in high-altitude areas (P<0.05). N3% was higher in females than in males in high-altitude areas (P<0.05). In males, REM% was higher in high-altitude areas (P<0.05). TST was higher in the 20-39 age group than in the 40-60 age group in high-altitude areas (P<0.05). Sleep efficiency was higher in the 40-60 age group in low-altitude areas compared to high-altitude areas, with the 20-39 age group showing higher sleep efficiency in high-altitude areas (P<0.05). In both age groups, N1% was higher in high-altitude areas (P<0.05). In low-altitude areas, N1% was higher in the 20-39 age group than in the 40-60 age group, whereas in high-altitude areas, it was lower in the 20-39 age group (P<0.05). N2% was higher in low-altitude areas in both age groups (P<0.05), with the 40-60 age group having a higher N2% in high-altitude areas (P<0.05). N3% was higher in the 20-39 age group in high-altitude areas (P<0.05). In low-altitude areas, N3% was lower in the 20-39 age group compared to the 40-60 age group, while in high-altitude areas, it was higher in the 20-39 age group (P<0.05). REM% was higher in high-altitude areas in both age groups (P<0.05) .

Conclusion

The factors of age and altitude have varying degrees of influence on total sleep time, sleep efficiency, N1%, N2%, and REM%. Age factors have a greater impact on sleep structure, the older the age, the shorter TST, the lower the sleep efficiency, the higher the proportion of N1. The higher the altitude, the greater the influence of age on sleep structure. In the high altitude area, the TST, sleep efficiency and N3% of the elderly population are lower, and the proportion of N1% is higher.

The Current Status of Non-surgical Treatment for Knee Osteoarthritis Patients in the Community: a Multi-center Cross-sectional Study

ZHOU Jun, LIU Xiaoyu, WANG Ping, YAN Yan, LIN Jiaming, ZHANG Kuayue, DONG Pengxuan, LIU Yuzhi, HU Xiaocong, MI Baohong, WANG Rongtian, CHEN Yuefeng, CHEN Weiheng

2024, 27(24):  2969-2975.  DOI: 10.12114/j.issn.1007-9572.2024.0015

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Background

Knee osteoarthritis (KOA) is a common clinical condition with a decades-long course. Long-term and personalised health management in community hospitals is the best way to prevent and treat KOA, and non-surgical treatment is an effective way to slow joint degeneration and postpone joint replacement surgery.

Objective

To understand the population characteristics, clinical staging and treatment modality characteristics of the population attending community hospitals for knee osteoarthritis, in order to provide a basis for optimising the treatment protocol for knee osteoarthritis at the grassroots level.

Method

All streets in the urban area of Beijing were randomly selected for the study using the whole cluster sampling method, and Hepingli Street in Dongcheng District, Beijing was censored for all patients who attended all community hospitals (7) belonging to the street from January to June 2022, and general information, medical history, personal history, clinical staging, K-L grading and treatment modalities were collected.

Results

A total of 3 615 KOA patients were included in this study, including 1 327 males (36.71%) and 2 288 females (63.29%), aged (71.8±13.3) years. There were 867 cases (23.98%) in the onset period, 2009 cases (55.57%) in the remission period and 739 cases (20.45%) in the rehabilitation period. Gender and age of patients with different clinical stages were not correlated with clinical stages (P>0.05), while BMI (K=0.235) and KL grading (K=0.406) were correlated with clinical stages (P<0.001). During the attack period, 4-5 kinds of treatment methods (48.67%) were combined, and the treatment methods were mainly traditional Chinese patent medicines and simple preparations for external use 598 cases (68.97%), 475 cases (54.79%) of traditional Chinese patent medicines and simple preparations for oral use, and 396 cases (45. 67%) of health education; in the remission stage, 2-3 treatment methods were used in combination (48.58%), mainly including 1 084 cases (53.96%) of traditional Chinese patent medicines and simple preparations for external use, 1 047 cases (52.12%) of health education and 790 cases (39.32%) of cupping; in the rehabilitation stage, 2-3 kinds of treatment methods were used in combination (47.23%). The main treatment methods were health education in 488 cases (66.04%), traditional exercises in 286 cases (38.70%), and external use of traditional Chinese patent medicines and simple preparations in 279 cases (37.75%). There was a correlation between clinical stage and type of combination therapy (K=0.356, P<0.05) .

Conclusion

KOA patients in community hospitals are mainly in remission, and treatment is often combined with various methods of traditional Chinese patent medicine and simple preparations, and traditional exercises are also widely used.

Correlation Analysis between Pan-immune Inflammatory Value, Systemic Immune-inflammatory Index, and Vulnerable Plaques in Patients with Acute Coronary Syndrome

HE Junhui, WAN Daguo, DONG Jing, ZHANG Juan

2024, 27(24):  2976-2981.  DOI: 10.12114/j.issn.1007-9572.2023.0679

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Background

The pan-immune inflammatory value (PIV) and systemic immune-inflammatory index (SII) are considered novel inflammatory markers for assessing the risk of atherosclerotic cardiovascular diseases. However, few studies have confirmed the impact of PIV and SII on atherosclerotic plaques.

Objective

To explore the relationship between PIV, SII, and vulnerable atherosclerotic plaques in patients with acute coronary syndrome (ACS) using optical coherence tomography (OCT) .

Methods

This retrospective study included 525 ACS patients treated at the Second Affiliated Hospital of Zhengzhou University from December 2020 to June 2023. All patients underwent coronary angiography and OCT imaging. Patients were further categorized into low PIV (<337.86, 79 cases) and high PIV (≥337.86, 139 cases) groups based on the optimal PIV cutoff value, as well as into low SII (<775.63, 74 cases) and high SII (≥775.63, 144 cases) groups based on the optimal SII cutoff value. Data were collected and analyzed. Multifactorial ordinal Logistic regression analysis was used to explore the influencing factors of TCFA. Receiver operating characteristic (ROC) curves were plotted for PIV and SII in diagnosing TCFA, and the area under the curve (AUC) was calculated. Based on the diagnostic criteria for thin-cap fibroatheroma (TCFA), patients were divided into a non-TCFA group (112 cases) and a TCFA group (106 cases) .

Results

The TCFA group had higher proportions of hypertension, diabetes, pan-PIV, SII, C-reactive protein (CRP), smoking history, and preoperative systolic pressure compared to the non-TCFA group (P<0.05). Multifactorial Logistic regression analysis showed that PIV (OR=1.015, 95%CI=1.010-1.020, P<0.001) and SII (OR=1.005, 95%CI=1.003-1.007, P<0.001) were risk factors for TCFA. ROC curve results indicated that the AUCs for PIV and SII in diagnosing TCFA were 0.785 (95%CI=0.725-0.845, P<0.001) and 0.707 (95%CI=0.639-0.776, P<0.001), respectively. The high PIV group showed higher rates of macrophage infiltration, punctate calcification, and vulnerable plaques than the low PIV group (P<0.05). The high SII group showed higher rates of macrophage infiltration, microchannels, and vulnerable plaques than the low SII group (P<0.05). The high PIV group had thinner fibrous caps, larger maximum lipid core angle, average lipid core angle, lipid core length, and lipid index compared to the low PIV group (P<0.05), and the high SII group had thinner fibrous caps, larger maximum lipid core angle, average lipid core angle, lipid core length, and lipid index compared to the low SII group (P<0.05) .

Conclusion

High levels of PIV and SII may be associated with the incidence of vulnerable plaques in patients with ACS. PIV and SII levels have potential value in assessing the characteristics and vulnerability of coronary atherosclerotic plaques in ACS patients.

Clinical Characteristics Analysis of Hospitalized Elderly Depression Patients with Subclinical Hypothyroidism

CHEN Ling, KONG Xiaoming, SUN Yan, HONG Hong, ZHANG Li

2024, 27(24):  2982-2986.  DOI: 10.12114/j.issn.1007-9572.2023.0619

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Background

Geriatric depression is a severe mental illness distinct from depression in other age groups, characterized by significant heterogeneity. Subclinical hypothyroidism (SCH) is a state of hypothyroidism with subtle clinical signs. The impact of SCH on elderly depression is easily overlooked, and the association between SCH and elderly depression is not well understood.

Objective

To explore the clinical characteristics of hospitalized elderly depression patients with SCH.

Methods

Depressed patients hospitalized in the Fourth People's Hospital of Hefei from April 2019 to March 2023 were included in the study and divided into the subclinical hypothyroidism depression (SCHD) group (n=108) and control depression (CD) group (n=110). General data of the subjects was collected, fasting venous blood samples were collected for testing biochemical markers, and the Hamilton Depression Rating Scale (HAMD-24) was used to assess depressive symptoms.

Results

The SCHD group showed a higher number of antipsychotic drug use, comorbid somatic diseases, days of hospitalization, and duration of the disease than the CD group (P<0.05). There was a statistically significant difference between the two groups in terms of the types of antidepressants used and the number of hospitalizations (P<0.05). The sleep disorder scores of patients in the SCHD group were higher than those in the CD group (P<0.05), and there was a significant difference in body mass and diurnal variation scores between the two groups (P<0.05). The SCHD group had higher levels of thyrotropin and lower levels of serum free triiodothyronine and free thyroxine than the CD group (P<0.05) .

Conclusion

Elderly depression patients with SCH exhibit unique clinical characteristics, including longer hospitalization, more frequent episodes, greater difficulty to cure, and poorer prognosis, making interventions for SCH essential.

Real-time Three-dimensional Echocardiography for Assessing Left Atrial Structural and Functional Changes in Mutation Carriers of Hypertrophic Cardiomyopathy

LIANG Qingqing, DUAN Yiquan, ZHU Rui, WU Nan, NA Lisha

2024, 27(24):  2987-2993.  DOI: 10.12114/j.issn.1007-9572.2023.0692

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Background

Hypertrophic cardiomyopathy (HCM) is a common primary cardiomyopathy that is closely associated with sudden death in adolescents and athletes. The disease progression of HCM is prone to structural and functional alterations in the left atrium, leading to increased incidence of acute cerebrovascular accidents, embolism and atrial fibrillation, and a severe influence on the quality of life.

Objective

To evaluate the structural and functional changes in the left atrium of family members of familial hypertrophic cardiomyopathy (FHCM) with a positive genotype but negative phenotype by real-time three-dimensional echocardiography (RT-3DE), providing valuable references for early identification, assessment and management of family members of FHCM.

Methods

A total of 141 HCM patients and family members admitted in the General Hospital of Ningxia Medical University from October 2021 to August 2022 were recruited. Blood samples were collected for genetic testing. Subjects were divided into G+P+ group with positive genotype and positive phenotype of ventricular wall thickening (n=54), G+P- group with positive genotype and negative phenotype (n=35) and G-P- group with negative genotype and negative phenotype (n=31). Baseline characteristics of subjects were collected. Two-dimensional transthoracic echocardiography (2DE-TTE) scans of the left atrium and ventricle and RT-3DE scans of the left atrium, and their relevant parameters were collected as well. Pearson correlation analysis was performed to identify the correlation between RT-3DE parameters of the left atrium and 2DE-TTE parameters of the left ventricle in subjects of G+P- group.

Results

Genetic testing identified 24 subjects carrying the titin (TTN) gene, 2 carrying both the TTN and tropomyosin 1 (TPM1) gene, 6 carrying the myosin binding protein C3 (MYBPC3) gene, 2 carrying the troponin I3 (TNNI3) gene, 9 carrying the myosin heavy chain 7 (MYH7) gene, 8 carrying both the MYBPC3 and TNNI3 genes, and 3 carrying both the TTN and MYH7 genes in G+P+ group. In G+P- group, 11 subjects carrying the TTN gene, 8 carrying the MYBPC3 gene, 3 carrying the TNNI3 gene, 8 carrying the MYH7 gene and 5 carrying both the MYBPC3 and TNNI3 genes. 2DE-TTE parameters were analyzed. Subjects in G+P+ group showed significantly higher left atrial diameter index (LADI), left atrial volume index (LAVI), end-diastolic interventricular septal thickness (IVST), end-diastolic left ventricular posterior wall thickness (LVPWT), left ventricular mass (LVM), left ventricular mass index (LVMI) and ratio of early diastolic flow velocity peak to annular velocities (E/e') compared with those of G-P- group and G+P- group, but significantly lower end-diastolic volume index (EDVI) and end-systolic volume index (ESVI) (P<0.05). The peak velocity blood flow from left ventricular relaxation in early diastole (the E wave) and late diastole caused by atrial contraction (the A wave) were significantly higher in subjects of G+P+ group than those of G-P- group (P<0.05). The A wave and E/e' were significantly higher in subjects of G+P- group than those of G-P- group (P<0.05). RT-3DE parameters of the left atrium were analyzed. Subjects in G+P+ group had significantly higher maximum (LAVImax) and minimum left atrial volume indices (LAVImin), and pre-contraction volume index (LAVIpre), but significantly lower left atrial total (LATEF), passive (LAPEF) and active ejection fractions (LAAEF) compared to those of G-P- group and G+P- group (P<0.05). LATEF and LAAEF were significantly lower in G+P- group than in G-P- group (P<0.05). Pearson correlation analysis showed positive correlations of LAVImax and LAVIpre with IVST (r=0.385 and 0.399, respectively; both P<0.05), positive correlations of LAVImax and LAVImin with LVM (r=0.371 and 0.432, respectively; both P<0.05), and negative correlations of LATEF and LAAEF with LVM (r=-0.375 and -0.401, respectively; both P<0.05) in G+P- group.

Conclusion

RT-3DE can reflect changes in left atrial function in family members of FHCM with positive genotype and negative phenotype by measuring atrial volumes, and they may already suffer from the left atrial dysfunction even when the atrial size is normal. Changes in their left atrial volume are positively correlated with changes in left ventricular wall thickness and mass, while functional changes are negatively correlated with the LVM.

The Impact of Dapagliflozin on the Incidence of Contrast-induced Nephropathy in Patients with Type 2 Diabetes Mellitus Underwent Percutaneous Coronary Intervention

LIU Xiaogang, YANG Shicheng, FU Naikuan, SHAO Dujing, ZHANG Peng

2024, 27(24):  2994-2999.  DOI: 10.12114/j.issn.1007-9572.2023.0916

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Background

Dapagliflozin is an effective drug for the treatment of type 2 diabetes mellitus (T2DM), which can also reduce the risk of nephropathy progression, decrease urinary protein and protect the heart. However, whether dapagliflozin can reduce the incidence of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in T2DM patients remain unclear.

Objective

To investigate the impact of dapagliflozin on the incidence of CIN in patients with T2DM underwent PCI.

Methods

According to the principle of 1∶1 propensity matching based on the use of dapagliflozin, a total of 484 T2DM patients who underwent PCI in the Department of Cardiology, Tianjin Chest Hospital from 2021 to 2023 were retrospectively consecutively enrolled in the study, of which 242 cases were in the dapagliflozin group and 242 cases were in the control group. The pre-PCI clinical data of the two groups were collected and compared, and the renal functions of the two groups were recorded before PCI, 48 hours after PCI and 1 week after PCI, including blood urea nitrogen (BUN), serum creatinine (Scr), creatinine clearance rate (Ccr), cystatin C (Cys-C), β2- microglobulin (β2-MG), and neutrophil gelatinase associated apolipoprotein (NGAL). The primary study endpoint was the incidence of CIN, and the secondary study endpoint was the change in renal function during the perioperative period of PCI. Multivariate Logistic regression was used to analyze the effect of dapagliflozin on the incidence of CIN after PCI in patients with T2DM.

Results

The incidence of CIN in patients in the dapagliflozin group was 6.2% lower than that in patients in the control group (12.0%). The difference was statistically significant (χ²=4.900, P=0.039). The CIN risk score and B-type natriuretic peptide of patients in the dapagliflozin group were higher than those in the control group (P<0.05). There was no statistically significant difference in BUN, Scr, Ccr, Cys-C, β2-MG, and NGAL levels between 2 groups before and 1 week after PCI (P>0.05). At 48 hours after PCI, the levels of Cys-C, β2-MG, and NGAL in the dapagliflozin group were lower than those in the control group (P<0.05). Multivariate Logistic regression analysis showed that high CIN risk score (OR=1.213, 95%CI=1.085-1.358, P=0.001) and B-type natriuretic peptide levels (OR=3.940, 95%CI=1.479-10.494, P=0.006) were independent risk factors for CIN after PCI in patients with T2DM, and the use of dapagliflozin (OR=0.338, 95%CI=0.159-0.717, P=0.005) was an independent protective factor for the development of CIN after PCI in patients with T2DM.

Conclusion

The use of dapagliflozin is an independent protective factor against the development of CIN after PCI in patients with T2DM, and dapagliflozin does not increase the risk of developing acute kidney injury after PCI in patients with T2DM and may reduce the incidence of CIN.

Relationship between Dietary Inflammatory Potential and Severity of Coronary Artery Disease in Acute Coronary Syndrome Patients

HU Guiping, LIN Ping, ZHAO Zhenjuan, WANG Yini, YAN Mingqiang, SUN Xiao

2024, 27(24):  3000-3006.  DOI: 10.12114/j.issn.1007-9572.2023.0469

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Background

The occurrence and development of acute coronary syndrome (ACS) are closely associated with inflammatory responses, but the relationship between dietary inflammatory potential and severity of coronary artery disease of ACS patients is currently unknown.

Objective

To investigate the relationship between dietary inflammatory potential evaluated by dietary inflammation index (DII) and severity of coronary artery disease in ACS patients.

Methods

Convenient sampling method was used to select 309 patients diagnosed as ACS for the first time by coronary arteriography in the Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University from April 2022 to March 2023, and they were divided into DII-1 group (from -8.35 to -4.56), DII-2 group (from -4.55 to -0.77), DII-3 group (from -0.76 to 3.02) and DII-4 group (from 3.03 to 6.81) according to the quartile of DII, into Q1 group (4-32 scores), Q2 group (34-52 scores), Q3 group (54-84 scores) and Q4 group (86-192 scores) according to the quartile of Gensini score. Demographic and clinical features, overall DII, and DII of nutrient were compared in ACS patients with different severity of coronary artery stenosis, multivariate Logistic regression analysis was used to analyze the relation of DII with the severity of coronary artery stenosis.

Results

There was significant difference in educational level, LDL-C, LP-a, overall DII, DII of total fat, saturated fatty acids, vitamin E, carotene in ACS patients with different severity of coronary artery stenosis, respectively (P≤0.05). After the correction of confounders of educational level, LDL-C and LP-a, the multivariate Logistic regression analysis showed that, DII-4 group was the influencing factor of Q2 group (OR=15.389, 95%CI=1.595-148.432), Q3 group (OR=15.102, 95%CI=1.620-140.788) and Q4 group (OR=17.319, 95%CI=1.901-157.807), respectively (P<0.05) ; DII of total fat (OR=3.831, 95%CI=1.195-9.094), saturated fatty acids (OR=8.562, 95%CI=1.519-48.258) and vitamin E (OR=0.640, 95%CI=0.460-0.890) was the influencing factor of Q4 group, respectively (P<0.05) .

Conclusion

Dietary inflammatory potential as well as inflammatory potential of nutrient total fat, saturated fatty acids and vitamin E are influencing factors of severity of coronary artery disease in ACS patients, thus clinicians should further strengthen the reasonable anti-inflammatory dietary guidance of ACS patients.

Original Research·Combination of Chinese and Western Medicine

Effect of Guilou Compound on Migration and Invasion of Adenomyosis Derived Cells

ZHANG Yinuo, WANG Zilu, SHI Yaxin, WANG Xin, GAO Xinyu, ZHANG Quanying, YU Mengdie, XU Li, SHI Wei

2024, 27(24):  3007-3014.  DOI: 10.12114/j.issn.1007-9572.2023.0491

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Background

Adenomyosis (AM) is a common and difficult gynecological disease, but its specific mechanism has not been fully elucidated. Traditional Chinese Medicine (TCM) has certain advantages in the treatment of AM, preliminary studies have shown that Guilou compound-releasing intrauterine system can significantly reduce the proliferation and invasion ability of endometrial cells in rats with AM model.

Objective

To investigate the effect of Guilou compound on the migration and invasion of human adenomyosis derived cells (AMDC), and study its effect on Rho/ROCK signaling pathway.

Methods

The experiment was completed from October 2021 to April 2023 in Central Laboratory of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine. The CCK-8 assay was used to detect AMDC cell viability and screen the optimal drug concentration. AMDC were treated with Guilou compound (50 and 100 mg/L), and the cell migration viability was detected by scratch assay, and cell invasion ability was detected by Transwell assay. The expression of RhoA, RhoB, RhoC, ROCK1, and ROCK2 at protein and mRNA levels was detected by Western Blotting/RT-qPCR assay. In the Rescue experiment, AMDC were treated with agonist U-46619 (1 μmol/L) and Guilou compound (100 mg/L), and the protein expression of RhoA, RhoB, RhoC, ROCK1, and ROCK2 was detected by Western Blotting.

Results

Compared with the control group, the survival rate of AMDC treated with 100 mg/L mass concentration of Guilou compound was not significantly decreased (P>0.05), which was the optimal drug concentration without affecting the cell viability, 50 and 100 mg/L mass concentrations of Guilou compound were selected for subsequent experiments. Compared with the control group, the migration and invasion ability of AMDC in the Guilou compound (50 mg/L, 100 mg/L) group was significantly inhibited (P<0.001), the protein and mRNA expression levels of RhoA, RhoC, ROCK1, and ROCK2 were significantly down-regulated (P<0.001), while the protein expression of RhoA, RhoC, ROCK1 and ROCK2 in the U-46619 1 μmol/L group were significantly up-regulated (P<0.001). Compared with the U-46619 1 μmol/L group, the protein expression of RhoA, RhoC, ROCK1, and ROCK2 in the U-46619 (1 μmol/L) combined with Guilou compound (100 mg/L) group was significantly down-regulated (P<0.001). There was no significant difference in protein and mRNA expression levels of RhoB in the control group and Guilou compound (50 mg/L, 100 mg/L) group (P>0.05) .

Conclusion

Guilou compound can effectively inhibit the migration and invasion ability of AMDC with the optimal drug concentration of 100 mg/L that does not affect the cell viability, Guilou compound can reverse the up-regulation of U-46619 on the protein expression of RhoA, RhoC, ROCK1 and ROCK2, thus inhibiting the the continuous progression of ectopic lesions of AM, which may be closely related to the regulation of Rho/ROCK pathway.

Efficacy of Zang Bi Formula in Treating Arthritis and Its Pulmonary Complications in Rheumatoid Arthritis Interstitial Lung Disease Mice

YANG Can, LI Ning, LI Xuefei, ZHAO Li, XU Hao, SHI Qi, WANG Yongjun, LIANG Qianqian

2024, 27(24):  3015-3022.  DOI: 10.12114/j.issn.1007-9572.2023.0257

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Background

Rheumatoid arthritis interstitial lung disease (RA-ILD) is one of the most common complications of rheumatoid arthritis (RA) that severely impairs the quality of life and survival. Zang Bi Formula (ZBF) is mostly used in clinical practice for patients with recurrent occurrence of RA. However, its mechanism of action and efficacy in RA-ILD still remain unclear. Objective To investigate the therapeutic possibilities and potential mechanisms of the ZBF on RA and RA-ILD.

Objective

To investigate the therapeutic possibilities and potential mechanisms of the ZBF on RA and RA-ILD.

Methods

From January 2022 to March 2023, a total of 14 tumor necrosis factor alpha-transgenic (TNF-Tg) mice were randomly divided into Saline group and ZBF group, with 7 mice in each group. At the same time, 7 wild-type (WT) mice in the same litter were randomly selected as the control group (WT group). Intragastric administration of ZBF 1.4 g/mL with 0.2 mL per time was given to mice of ZBF group once a day, and those in the WT group and Saline group were given an equal amount of normal saline via intragastric administration. After the intervention for 8 weeks, hematoxylin&eosin (H&E) staining of mouse ankle tissues was performed to observe the inflammatory cell area. Alcian blue-orange and tartrate-resistant acid phosphatase (TRAP) staining was performed to observe the cartilage area and bone area ratio, as well as the osteoclast area, respectively. The area proportion of inflammatory cells, fibrosis and T-cell/B-cell proportion in mouse lung tissues were observed by H&E staining, Masson staining and immunofluorescence staining, respectively.

Results

Mice in the Saline group had significantly increased inflammatory cell infiltration, synovial hyperplasia, and ankle tissue destruction. Inflammation of the ankle joint was alleviated in the ZBF group. The proportion of inflammatory cells in the Saline group was significantly higher than that of the ZBF group and WT group, which was significantly higher in the ZBF group than that of the WT group (P<0.05). Mice in the Saline group had significant damages to the sagittal plane of the talus of the ankle joint and bone erosion. Bone damages of the ankle joint and erosion were significantly alleviated in ZBF group, showing a gradually cleared boundary of the sagittal plane of the talus and increased bone mass. The proportions of cartilage area and bone area in the Saline group were significantly lower than those of ZBF group and WT group, which were significantly lower in the ZBF group than those of WT group (P<0.05). Mice in the Saline group presented massive infiltration of red-stained osteoclasts in the ankle joint, which was significantly alleviated in mice of ZBF group. The area of osteoclasts in the ZBF group was significantly smaller than that of the Saline group (P<0.05). Mice in the Saline group had mild-to-moderate inflammatory cell infiltration diffusely around the pulmonary interstitium, blood vessels and bronchi, thickening of the walls of the middle and small arteries, reduced alveolar intervals and obvious damages to lung tissues. Inflammatory cells infiltrated in the pulmonary interstitium surrounding tissues of the trachea and blood vessels were reduced and the boundary of the lungs were cleared in mice of ZBF group, presenting an improved lung structure. The proportion of inflammatory cells area in the Saline group was significantly higher than that of the ZBF group and WT group, which was significantly higher in the ZBF group than that of the WT group (P<0.05). Mice in the Saline group had significantly enlarged areas of blue collagen fibers around blood vessels and trachea and thickening of the alveolar or bronchial walls. Mice in the ZBF group had reduced areas of blue collagen fibers around blood vessels and trachea and improved lung structure. Pulmonary fibrosis scores of the lung were significantly higher in the Saline group than those of ZBF group and WT group, which were significantly higher in the ZBF group than those of WT group (P<0.05). T lymphocytes cells and B lymphocytes cells increased significantly in mouse lung tissue of the Saline group, and most of them surrounded the pulmonary blood vessels and bronchi, forming a follicle-like structure lacking a germinal center. The follicle-like structures were less observed in mouse lungs of the ZBF group. The area proportions of B lymphocytes cells and T lymphocytes cells in the Saline group were significantly higher than those of the ZBF group and WT group, which were significantly higher in the ZBF group than those of WT group (P<0.05) .

Conclusion

ZBF not only reduced ankle injury in TNF-Tg mice, but also improved their lungs inflammation and fibrosis, reducing the numbers of B lymphocytes cells and CD₃⁺ T lymphocytes cells in lung tissue.

Advances in Traditional Chinese Medicine Regulating Mitochondrial Quality Control in the Treatment of Ischemic Stroke

SU Ziwei, MA Yan, ZHOU Yanzhang, ZHOU Zhiliang

2024, 27(24):  3023-3030.  DOI: 10.12114/j.issn.1007-9572.2023.0632

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Ischemic stroke is the most common cerebrovascular accident and is increasingly becoming a serious global health problem. Mitochondrial quality control disorder is an important mechanism of neuronal death induced by cerebral ischemia, and the maintenance of mitochondrial function is essential for promoting neuronal survival and improving neurological function. Mitochondrial quality control mainly involves mitochondrial oxidative stress, mitochondrial dynamics, mitochondrial autophagy, mitochondrial biogenesis, etc., which is an important condition for stabilizing the normal structure of mitochondria and exerting the normal function of mitochondria. In recent years, Traditional Chinese Medicine (TCM) has significantly improved the clinical symptoms of patients with ischemic stroke by affecting the structure and function of mitochondria through multi-perspective, multi-pathway, multi-target regulation of mitochondrial quality control, which has received extensive attention from scholars. This article summarizes the experimental studies and clinical observations on the application of effective compound components of TCM and TCM compound to regulate mitochondrial quality control in the treatment of ischemic stroke in recent years, further explains the pathogenesis of ischemic stroke, clarifies the regulatory mechanism of TCM on mitochondrial quality control, and summarizes the scientific connotation and shortcomings of TCM in the treatment of ischemic stroke, in order to provide ideas and methods for further clinical application of TCM in the treatment of ischemic stroke.

Review & Perspectives

Advances in the Role of Short-chain Fatty Acids in Type 2 Diabetes

JIANG Rongsheng, ZHANG Long, GUAN Qifan, ZHANG Jing, WU Yuanfeng, LIU Mingjun

2024, 27(24):  3031-3037.  DOI: 10.12114/j.issn.1007-9572.2023.0533

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Short-chain fatty acids (SCFAs) play a major mediating role in gut microbiota regulation of host metabolism and are strongly associated with type 2 diabetes mellitus (T2DM), which improves glycemic, body weight, and lipid indices in T2DM patients. Although it has been suggested that SCFAs are expected to be novel therapeutic targets for T2DM, no review has been conducted. Therefore, this paper summarizes the biological properties of SCFAs, discusses the evidence that SCFAs regulate appetite, inflammation, pancreatic β-cells, lipid metabolism and hepatic glycogen metabolism, further clarifies the progress of research on regulating the role of SCFAs in T2DM and their mechanisms, and explores the potential of regulating SCFAs for the treatment of T2DM.

Advances in Pathogenesis, Diagnosis and Treatment of Ovarian Teratoma Associated Anti-N-methyl-D-aspartate Receptor Encephalitis

ZHANG Shan, ZHANG Meng, XU Xin, LIAO Lixin, SUN Mingjun, MA Haiyan, ZHANG Haibin, GUO Yuzhen

2024, 27(24):  3038-3043.  DOI: 10.12114/j.issn.1007-9572.2023.0363

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Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune encephalitis that is a rare complication of ovarian teratoma. The primary treatment is surgical resection of the tumor combined with immunotherapy, however, the pathogenesis of ovarian teratoma associated anti-NMDAR encephalitis is still unclear. In addition, the patients present with various clinical manifestations, with neurological manifestations predominating, which is easy to be misdiagnosed and overlooked, requiring joint diagnosis and treatment by gynecologists and neurologists. This article briefly describes the structure and function of NMDAR, reviews the previous research results on ovarian teratoma associated anti-NMDAR encephalitis, and summarizes the research progress on its pathogenesis, early diagnosis, differential diagnosis, treatment, prognosis and recurrence, aiming to provide theoretical basis and ideas for better diagnosis and treatment of ovarian teratoma associated anti-NMDAR encephalitis.

Advances in the Application of Vagus Nerve Stimulation in Inflammation and Apoptosis Mechanism of Chronic Heart Failure

HU Yuchi, DAI Songyuan, ZHAO Ling, ZHAO Lulu

2024, 27(24):  3044-3050.  DOI: 10.12114/j.issn.1007-9572.2023.0693

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As a crucial component of the cardiac autonomic nervous system, the cardiac vagus nerve plays a significant role in the management of chronic heart failure. In recent years, several studies have found that vagus nerve stimulation protects cardiac function and delays the progression of chronic heart failure by reducing the expression of inflammatory factors and related proteins, apoptosis-related proteins, and improving myocardial function and ventricular remodeling. However, there are limited reports related to the mechanism of inflammation and apoptosis of the vagus nerve in chronic heart failure. Hence, this article reviews the anatomy of the cardiac vagus nerve, potential treatment mechanisms, practical parameters of vagus nerve stimulation, and the recent applications and clinical progress of vagus nerve stimulation in inflammation and apoptosis mechanisms in chronic heart failure, in order to provide a reference for the future related research.

Community Medical Practice

Exploration and Practice of an Innovative Model of Community-based Popularization of Knowledge in Critical Care Medicine

ZOU Hai, CHEN Zhenyao, HE Xigan, MOU Xiaozhou, ZHANG Zhongwei, ZHU Biao, WEI Peng, LIU Jing

2024, 27(24):  3051-3056.  DOI: 10.12114/j.issn.1007-9572.2023.0535

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Popularization of medical knowledge plays an important role in promoting effective communication and understanding between doctors and patients. Based on the shortcomings of the model of popularization of traditional medical knowledge, such as unidirectional dissemination, insufficient depth of information and difficulty in understanding, this paper explores the types and advantages of innovative models of popularization of medical knowledge by searching the literature. Currently, the main models of community-based popularization of medical knowledge include traditional media (TV, radio, newspapers), lectures, special report, books, brochures, etc., which are limited in terms of the effectiveness of information dissemination, lack of interaction and personalization, as well as continuity and traceability. In this paper, an in-depth discussion was conducted on the innovative model of popularizing the knowledge of critical care medicine in the community, and many new models of popularizing knowledge, including cartoons, animation, virtual reality, augmented reality, and Internet platforms were proposed, and useful community practice was carried out. The results of the practice showed that the number of reading hits and the satisfaction with popularizing science were significantly increased under the innovative models of popularization of knowledge. The innovative model of popularization of knowledge can improve the efficiency of medical knowledge popularization, enhance patient participation, bridge the gap of medical knowledge, and provide customized health management solutions, which is of a significant advantage, however, it also has limitations such as higher dependence on technology and equipment, and the model of popularization of knowledge still needs to be continuously innovated and explored.

Discussion on the Practice of Narrative Medicine in Primary Care from the Perspective of General Practitioners

WANG Lin, WANG Yixin, CHEN Tingyan, LIN Shaohai, ZHANG Yonghui

2024, 27(24):  3057-3060.  DOI: 10.12114/j.issn.1007-9572.2023.0181

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Primary health care provided by general practitioners is an important safeguard for the achievement of universal health coverage. With the continues progress of new medical reform, the number of primary care settings, general practitioners and outpatient visits have increased significantly compared with one decade ago. General practitioners, as the main body of implementation of general practice, coincides with the concept of narrative medicine in terms of patient-centeredness and attention to both psychological and social factors of the patients. Narrative medicine is medicine practiced by clinical workers who have narrative ability, with strong theory and weak practice in our country at present. From the perspective of general practitioners, this paper presents the positive influence of narrative medicine practice in primary care on general practitioners in the form of parallel medical records.

Tools Development Research

Research Progress on Application of Patient Decision Aid in the Medication of Elderly Patients with Type 2 Diabetes

DAI Xianggui, LI Zhen, LI Xuan, ZHANG Siqi, LIU Dongling, QIN Yuelan

2024, 27(24):  3061-3066.  DOI: 10.12114/j.issn.1007-9572.2023.0861

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Elderly patients with type 2 diabetes mellitus often face the problems of multimorbidity and multiple medications, and these conditions often lead to irrational or inappropriate medication use, significantly affecting patient outcomes and quality of life, making early and effective medication decisions particularly important. As an important supplement to medication support information, decision support tools, including electronic health record-based systems, mobile applications, online health platforms, etc., provide personalized, evidence-based medical information to help patients understand medication regimens, assist patients and healthcare professionals in making more rational medication decisions, enhance the appropriateness and safety of medication, and reduce the risk of drug interactions, thereby improving the overall treatment of patients and reducing the risk of drug interactions. The application of medication management in elderly patients with type 2 diabetes mellitus has made significant progress, thus improving the overall outcome and quality of life of patients. This article summarizes the current situation of medication use in elderly patients with type 2 diabetes mellitus, the influencing factors, types, application methods and their roles of decision aids, aiming to provide reference for the development of medication decision aids for this population in China.