Table of Content

15 November 2024, Volume 27 Issue 32

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World General Practice

Translation of Selected Passage of AI in General Practice: a Tale of Pragmatism, Caution, and Optimism

YANG Hui

2024, 27(32):  0-B.  DOI: 10.3760/cma.j.issn.1007-9572.2024.32.101

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Guidelines·Consensus

Expert Consensus on Screening and Prevention of Diabetic Microvascular Disease for Primary Care (2024)

Diabetes and Microcirculation Professional Committee of Chinese Society of Microcirculation, Primary Endocrine and Metabolic Diseases Group of the Chinese Society of Endocrinology

2024, 27(32):  3969-3986.  DOI: 10.12114/j.issn.1007-9572.2024.0163

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Diabetic microvascular disease (DMiVD) is the most common chronic complication of diabetes mellitus, and early identification and effective intervention can significantly improve patients' quality of life and prognosis. The Diabetes and Microcirculation Professional Committee of Chinese Society of Microcirculation and the Primary Endocrine and Metabolic Diseases Group of the Chinese Society of Endocrinology have convened experts in the field to revise the Expert Consensus on Screening and Prevention of Diabetic Microvascular Diseases for Primary Care (2024), based on the 2021 edition, considering the latest research advances and the specific needs of primary care. This consensus elaborates the screening methods, comprehensive management and prevention strategies for DMiVD (diabetic retinopathy, diabetic kidney disease, distal symmetric polyneuropathy and diabetic cardiomyopathy), clarifies the graded diagnosis and treatment and referral processes, emphasizes the importance of preventing and treating DMiVD, and offers guidance and recommendations for physicians, particularly primary care physicians and general practitioners. The aim is to reduce the incidence, progression, and disability associated with DMiVD, ultimately lowering morbidity and mortality rates.

Original Research

Clinical Characteristics and Risk Factors of Patients with Pulmonary Infarction Secondary to Intermediate and High-risk Pulmonary Embolism Misdiagnosed as Pneumonia

LYU Guangyu, SUN Wanjun, ZHOU Qianqian, CHEN Xianmeng, LIU Xuehan, HU Xiaowen

2024, 27(32):  3987-3992.  DOI: 10.12114/j.issn.1007-9572.2024.0047

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Background

Although the number of case reports on pulmonary infarction (PI) secondary to pulmonary embolism (PE) is increasing in recent years, its misdiagnosis remains common, mainly as pneumonia. In patients with intermediate and high-risk pulmonary embolism, delays in diagnosis and timely treatment would lead to poor prognosis.

Objective

By analyzing the pneumonia-misdiagnosed cases of patients with PI, we summarized their clinical characteristics and related risk factors, and constructed a multivariate joint model to improve the accurate diagnosis rate at early stage.

Methods

This retrospective study included the hospitalized patients with pulmonary embolism at the First Affiliated Hospital of USTC from January 2017 to December 2023. In the group of pneumonia-misdiagnosed patients with intermediate to high-risk PI, we analyzed the clinical characteristics and compared the differences between the misdiagnosed groups and control group. Furthermore, using a multivariate Logistic regression analysis, we explored the independent predictive factors of the delayed diagnosis, analyze the predictive value of various indicators for the misdiagnosis by ROC curves, and compared the AUC values using Delong test.

Results

Among 101 cases of PI patients, 70 of them were misdiagnosed as pneumonia. From 2017 to 2023, the misdiagnosis rate gradually decreased in percentages of 100.0%, 83.3%, 74.1%, 71.4%, 63.2%, 66.7%, and 50.0%, respectively (χ²_trend=6.672, P=0.010). Based on the results of multivariate Logistic regression analysis, the characteristics of over sixty-years-old age (OR=18.271, 95%CI=4.373-76.339, P<0.001), fever (OR=16.073, 95%CI=3.510-73.786, P<0.001), chest pain (OR=6.660, 95%CI=1.571-28.233, P=0.010) and non-dyspnea (OR=7.783, 95%CI=2.049-30.249, P=0.003) were independent predictive factors for the misdiagnosis. Therefore, a multivariate joint model was constructed as the following equation: Y=-6.624+0.095×A (factor of age) +2.510×F (factor of fever) +2.683×N (factor of non-dyspnea chest pain). The model indicated the PI misdiagnosis parameters as AUC under the curve (OR=0.880, 95%CI=0.802-0.959, P<0.001), sensitivity (0.871) and specificity (0.806). According to Delong's tests, the predictive values were superior to single-factor indicators of age (Z=2.771, P=0.006), fever (Z=4.653, P<0.001) and non-dyspnea chest pain (Z=4.014, P<0.001) .

Conclusion

Although the misdiagnosis rate of pulmonary infarction has decreased in recent years, clinicians should keep alert to the differential diagnosis of pulmonary infarction and pneumonia in elderly PE patients with symptoms of fever and non-dyspnea chest pain.

Application of Head Shaking Tilt Suppression Test and Video Head Impulse Test in the Antidiastole of Vestibular Migraine and Meniere's Disease

LIU Juan, ZHAO Jing, CHEN Zewen, LI Chang, LI Danling, FU Rong

2024, 27(32):  3993-4000.  DOI: 10.12114/j.issn.1007-9572.2023.0609

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Background

As revealed by previous studies, the head shaking tilt suppression test (HSTST) is associated with the vestibular cerebellum-mediated central storage mechanism and the video head impulse test (vHIT) is crucial for the diagnosis of peripheral vestibular diseases.

Objective

To explore the clinical application value of HSTST and vHIT in vestibular migraine (VM) and Meniere's disease (MD) .

Methods

Patients presenting with vertigo or dizziness as the primary complaint and diagnosed with VM and MD were selected from the Neurology Department of the Second People's Hospital of Guiyang from July 2021 to December 2022. After collecting their medical history and performing bedside examinations, pure tone audiometry test was conducted on those with hearing impairment. All patients completed vestibular function tests, including head shaking test (HST), HSTST, caloric test, and vHIT, were performed, followed by calculating the tilt suppression index (TSI). Then the Clinical features and examination results of VM and MD patients with HST positive were compared, and the ROC curve of TSI was plotted to distinguish between the two groups of patients.

Results

Among the 50 VM patients involved in the study, 22 (44.0%) were HST positive, including 19 (86.4%) exhibiting horizontal nystagmus and 3 (13.6%) showing vertical nystagmus. Among the 45 MD patients, 23 (51.1%) were HST positive, all of whom were horizontal nystagmus. The analysis of the patients with HST positive showed that the female to male ratio in VM and MD patients was 4.5∶1 and 1∶1.3, respectively. The prevalence of family history of headaches was higher in VM patients compared to MD patients (P<0.05). VM patients exhibited lower proportions of vomiting, tinnitus, ear tightness, and hearing loss symptoms (31.8%, 18.2%, 13.6%, 13.6%) compared to MD patients (73.9%, 100.0%, 82.6%, 100.0%), with a higher proportion of accompanying headache symptoms (77.3%) than MD patients (8.7%) (P<0.05). Pure tone audiometry revealed a higher hearing loss rate in MD patients compared to VM patients (P<0.001). Significant differences were observed in vHIT between VM and MD patients (P<0.05). Then the TSI differed significantly between VM and MD patients [ (25.41±12.15) % and (78.71±13.76) %, respectively] (P<0.05). From ROC curves, the area under the curve (AUC) was 0.962 (95%CI=0.91-1.00) with a cut-off point at 0.66 (sensitivity=0.90, specificity=0.95) .

Conclusion

Vestibular migraine primarily involves a central mechanism, and HSTST combined with vHIT can be used as auxiliary examination tools to differentiate diagnosis between VM and MD.

Evaluation Value of Peripheral Absolute Eosinophil Count for the Prognosis of Lung Cancer

YI Fen, WANG Yong, XU Aihui

2024, 27(32):  4001-4008.  DOI: 10.12114/j.issn.1007-9572.2023.0899

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Background

Lung cancer remains a significant global health challenge, with both its incidence and mortality rates on the rise worldwide. Despite numerous investigations into its etiology, progression, and prognostic indicators, a pressing need persists for straightforward and efficient methods to assess the early prognosis of lung cancer.

Objective

This study aims to investigate the prognostic significance of absolute eosinophil count level in patients with lung cancer.

Methods

We conducted a retrospective analysis of clinical data from 152 lung cancer patients admitted to the First Affiliated Hospital of Anhui Medical University between June 2019 and December 2022, with follow-up conducted until May 2023. Patients experiencing tumor recurrence, metastasis, or mortality were categorized into the poor prognosis group, while the remaining patients comprised the good prognosis group. Progression-free survival time (PFS) was meticulously recorded. Group comparisons were made to identify factors influencing lung cancer prognosis, followed by multivariate Cox regression analysis. Additionally, Kaplan-Meier survival analysis was employed to assess the impact of absolute eosinophil count on survival. Receiver operating characteristic (ROC) curve analysis was utilized to evaluate the prognostic efficacy of lung cancer, with the area under the ROC curve (AUC) calculated to gauge its predictive value. To further explore the relationship between eosinophil counts and lung cancer, datasets were procured from genome-wide association analysis pooled data and the International Consortium for Lung Cancer Research for Mendelian randomization analysis, elucidating potential causal links.

Results

Patients were stratified into good and poor prognosis groups based on their lung cancer prognosis. A statistically significant contrast in absolute eosinophil count was observed between these groups (P=0.004). Multivariate Cox regression analysis highlighted absolute eosinophil count as an independent risk factor for lung cancer survival outcomes (HR=1.58, 95%CI=1.03-2.44, P=0.037). Kaplan-Meier analysis revealed that the PFS time for patients with elevated absolute eosinophilic counts (n=76) (618.44±72.57 ) days was shorter compared to those with normal counts (n=76) (842.32±76.04) days (P=0.048). Furthermore, the AUC was 0.634. Mendelian randomization findings indicated that eosinophil count might serve as an adverse overall risk factor for lung cancer in the East Asian population (OR=1.07, 95%CI=1.01-1.13, P=0.030) .

Conclusion

The elevation of absolute eosinophil count levels may adversely impact the prognosis of lung cancer patients.

Study on Effectiveness of Psychological Intervention for Depression in Newly Diagnosed HIV/AIDS-infected Patients and the Relationship with CD₄⁺ T Cell Counts

LIU Yun, LU Heli, ZOU Qing, YUAN Yefeng

2024, 27(32):  4009-4014.  DOI: 10.12114/j.issn.1007-9572.2023.0795

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Background

HIV/AIDS is associated with depression, which increases the risk of HIV-associated neurocognitive disorders (HAND) and reduces patient compliance with antiretroviral therapy (ART), exacerbating the risk of HIV transmission. Few domestic studies have reported on the effectiveness of psychological intervention for depressed patients of people living with HIV/AIDS (PLWHA) newly diagnosed and its correlation with CD₄⁺ T cell counts.

Objective

To explore the effectiveness of psychological intervention for newly diagnosed PLWHA with depression and its correlation with CD₄⁺ T cell counts, providing a reference for AIDS clinical diagnosis and treatment.

Methods

From April 2020 to June 2022, a convenient sampling method was used to select newly diagnosed PLWHA with depression from some ART-designated hospitals in Jiangxi Province. While they were diagnosed, ART and psychological intervention were immediately initiated, and the total period of intervention was 12 weeks. Before and after the intervention, the Hamilton Depression Rating Scale (HAMD) and Hamilton Anxiety Rating Scale (HAMA) were used for evaluation, and CD₄⁺ T cell counts were calculated for analysis.

Results

A total of 200 newly diagnosed PLWHA with depression were included, 178 cases of which were effectively followed up with an effective rate of 89.0%. Among 178 cases, 88 were mild to moderate depression (49.4%), 90 were major depressive disorder (50.6%), and 173 cases were accompanied by anxiety (97.2%). The mean CD₄⁺ T cell count before intervention was (346.39±156.87) cells/μL, and it was (421.93±149.61) cells/μL after intervention. After intervention, the CD₄⁺ T cell counts of newly diagnosed PLWHA with depression were higher than before intervention (t=10.971, P<0.05), and the total and factor scores of HAMD, HAMA were all lower than before intervention (P<0.05). Before the intervention, the total scores of HAMD were correlated with the grades of CD₄⁺ T cell counts negatively (500 cells/μL as the cutoff value) (r_s=-0.157, P=0.036) and the scores of HAMA positively (r_s=0.764, P<0.001). After the intervention, the total scores of HAMD were correlated with post-intervention CD₄⁺ T cell counts negatively (r_s=-0.150, P=0.046) and the total scores of HAMA strongly positively (r_s=0.939, P<0.001). In newly diagnosed PLWHA with depression, the total scores of HAMD and HAMA of patients with CD₄⁺ T cell counts <500 cells/μL were higher than those with CD₄⁺ T cell counts≥500 cells/μL (P<0.05) before intervention.

Conclusion

The severity of depression in newly diagnosed PLWHA is associated with CD₄⁺ T cell counts, which could be significantly improved by professional psychological intervention.

Effect of Qingpeng Ointment Combined Ultrasound Penetration in the Treatment of Knee Injury Induced by Military Training

XIAO Hua, WANG Yunyun, WANG Yi, DONG Lin, CHANG Cong, LU Jiachun, HU Yonghe, WANG Wenchun

2024, 27(32):  4014-4020.  DOI: 10.12114/j.issn.1007-9572.2023.0559

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Background

Knee joint injury is a common military training injury, which seriously affects the combat effectiveness of soldiers. In recent years, the prevention and treatment of military training injury becomes more and more important. Ultrasound therapy and Qingpeng ointment are commonly used to treat sports training injuries. However, the protective effectiveness of ultrasound combined with the external use of Qingpeng ointment for knee injury in sports training injury patients is less reported.

Objective

To comprehensively assess the clinical efficacy of Qingpeng ointment combined with ultrasound therapy in the treatment of knee injuries caused by military training.

Methods

Fifty-six patients with knee injury who were treated in the Fifth Pentry Outpatient Clinic, the General Hospital of the Western Theater Command PLA from May to July 2022 were selected and randomly grouped into control group (4 cases fell off during the study, n=24) and treatment group (n=28) using IBM-SPSS 25.0 statistical software to generate random numbers. The control group was given ordinary coupling agent ultrasonic therapy, and the treatment group was given Qingpeng ointment ultrasonic therapy, once a day, 10 times a course, a total of 2 courses. The Lysholm knee joint score, VAS score, Hamilton Depression Scale-17 (HAMD-17), and knee range of motion were compared between the two groups after a twenty-minute intervention.

Results

Before treatment, there was no significant difference in Lysholm knee joint score, VAS score, HAMD-17 score and knee joint motion between the two groups (P>0.05). After 2 courses of treatment, the passive joint motion of the knee in the treatment group was better than that in the control group (P<0.05). After 2 courses of treatment, Lysholm knee joint score in 2 groups was higher than before treatment, and VAS score was lower than before treatment (P<0.05). Compared with before treatment, the active and passive joint motion in the treatment group increased after 2 courses of treatment (P<0.05). Compared with before treatment, HAMD-17 score in the treatment group was decreased after 2 courses of treatment (P<0.05) .

Conclusion

Qingpeng ointment combined with ultrasound therapy and ultrasound therapy with ordinary coupling agents can significantly improve knee joint function, reduce pain in patients with knee injuries. As a special coupling agent for ultrasound therapy, Qingpeng ointment has certain advantages over ordinary coupling agents.

Original Research·Combination of Chinese and Western Medicine

Study on the Evidence Map of Manual Therapy of Clinical Advantageous Diseases in Traditional Chinese Orthopedics

FENG Tianxiao, WANG Xu, BU Hanmei, QIN Xiaokuan, XIAO Xiangyu, WEI Xu, ZHU Liguo

2024, 27(32):  4021-4028.  DOI: 10.12114/j.issn.1007-9572.2023.0878

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Background

Establishing the advantageous diseases in the field of traditional Chinese orthopedics treated with manual therapy will promote the development of manual techniques and dominant discipline. However, the current evaluation and selection lack a quantitative evaluation process based on evidence-based medicine.

Objective

To systematically review systematic reviews of diseases in the field of traditional Chinese orthopedics treated with manual therapy using evidence mapping methodology and explore the advantageous diseases in this field.

Methods

Computerized searches were conducted in PubMed, Embase, Cochrane Library, Web of Science, SinoMed, China National Knowledge Infrastructure, Wanfang Data, and VIP database to collect systematic reviews of diseases in the field of traditional Chinese orthopedics treated with manual therapy from inception to March 5, 2023. The evidence distribution characteristics were presented using a combination of charts and text.

Results

A total of 126 systematic reviews published from 2003 to 2023 were included, showing an overall increasing trend in the quantity of relevant studies both domestically and internationally. Methodological quality assessment results indicated that 13 reviews were of moderate quality, 64 were of low quality, and 49 were of very low quality. The evidence map showed that the research evidence in the field of traditional Chinese orthopedics treated with manual therapy mainly focused on 18 clinical diseases, including cervical spondylosis, low back pain, knee osteoarthritis, lumbar disc herniation, ankle sprain, adhesive capsulitis of the shoulder, cervicogenic headache, atlantoaxial subluxation, distal radius fracture, lateral epicondylitis of the humerus, carpal tunnel syndrome, lumbar sprain, scoliosis, hip osteoarthritis, fibromyalgia syndrome, myofascial pain syndrome, rotator cuff injury, and supracondylar fracture of the humerus, demonstrating beneficial or potentially beneficial effects.

Conclusion

Manual therapy is widely used in the clinical practice of traditional Chinese orthopedics. However, due to methodological shortcomings and a lack of research evidence on safety and cost-effectiveness, future efforts should focus on multi-level inter-agency cooperation to establish sound evaluation standards and systems, improve research quality, update research evidence, and further explore the advantages of manual therapy in the field of traditional Chinese orthopedics.

Core Problems and Solving Strategies of the Research on the Law of TCM Syndrome and Treatment Based on Data Driven

ZHEN Qian, ZHU Rong, WANG Zhongrui, CUI Weifeng, YAN Shuxun, SHAO Mingyi, YU Haibin, FU Yu

2024, 27(32):  4029-4032.  DOI: 10.12114/j.issn.1007-9572.2023.0311

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Treatment based on syndrome differentiation is the core diagnostic and therapeutic thinking of traditional Chinese medicine (TCM), which is the key to determine clinical efficacy. Nowadays, research based on clinical data is the main method to explore the law of TCM syndrome and treatment, but the internal relationship of the key factors of "disease-syndrome-formula-medicine-effect" has not been truly and comprehensively analyzed, resulting in low clinical value of research results. Therefore, the author systematically sorted out the core problems of poor matching between electronic medical record and clinical research, the effect of data governance on data accuracy, difficulties to discover the law of TCM syndrome and treatment by data analysis methods. In addition, in the context of data driven, the big data platform of TCM clinical research should be established, and the data governance and analysis technology with artificial intelligence as the core should be developed, so as to realize the integration of clinical practice and research, providing new ideas and methods for the research of the law of TCM syndrome and treatment and promoting the development of TCM.

Original Research·Hepatocellular Carcinoma Section

The Value of Serum VEGF in Evaluating the Clinical Efficacy of TACE Alone or Combined with Target Immunotherapy in Advanced Hepatocellular Carcinoma

HU Lingxi, LI Mei, FU Yiwei, LU Lixia, MA Xiaoxuan, WANG Rongqi, NAN Yuemin

2024, 27(32):  4033-4039.  DOI: 10.12114/j.issn.1007-9572.2023.0556

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Background

The treatment of intermediate and advanced-stage hepatocellular carcinoma poses significant challenges, prompting a research focus on the effective evaluation and enhancement of therapies. Transarterial chemoembolization (TACE) combined with immunotherapy has exhibited potential, however, there is a need for further validation of its efficacy and the identification of biomarkers that can predict patient prognosis.

Objective

To explore the clinical value of serum vascular endothelial growth factor (VEGF) in evaluating the clinical efficacy of TACE alone or combined with target immunotherapy in advanced hepatocellular carcinoma.

Methods

The clinical data of 113 newly diagnosed patients with advanced hepatocellular carcinoma were hospitalized in the Third Hospital of Hebei Medical University from January 2021 to July 2022 were analyzed. According to the treatment regimen, the patients were divided into TACE group (n=66), TACE combined targeting group (n=22), and TACE combined with target immunity group (n=25). Tumor markers such as VEGF, alpha fetoprotein (AFP), and protein induced by vitamin K antagonist-Ⅱ (PIVKA-Ⅱ) were detected before and after treatment. According to the modified response evaluation criteria in solid tumors (mRECIST), patients were followed up for 3, 6, and 12 months after treatment to evaluate the clinical efficacy of advanced hepatocellular carcinoma. The objective response rate (ORR) and disease control rate (DCR) of the patients were analyzed. The median progression free survival (PFS) was calculated by the Kaplan-Meier and the survival curve was drawn. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of serum VEGF and related combined serum tumor markers for the clinical efficacy of advanced hepatocellular carcinoma.

Results

The ORRs of the TACE group, TACE combined targeting group and TACE combined target immunity group were after 12 months of follow-up were 17.14% (6/35), 33.33% (4/12), and 54.55% (6/11), respectively, and the DCRs were 28.57% (10/35), 41.67% (5/12), and 72.73% (8/11), respectively. The ORR and DCR of the TACE combined target immunity group after 12 months of treatment were significantly higher than those of the TACE group, with statistically significant differences (P<0.05). The median PFS of TACE combined with target immunity group (15.039 months) was better than that of TACE group (8.757 months) and TACE combined targeting group (9.680 months) (P<0.05). The frequency of TACE in TACE combined with target immunity group after 12 months of follow-up was significantly less than that in TACE groupand TACE combined targeting group (P<0.05). The difference of serum VEGF before and after treatment in TACE combined targeting group and TACE combined target immunity group was significantly higher than that in TACE group, and the difference was statistically significant (P<0.05). The AUC of the difference in serum VEGF before and after treatment for predicting the clinical efficacy of advanced hepatocellular carcinoma was 0.748 (P<0.001), and the sensitivity and specificity were 0.909 and 0.629, respectively. The AUCs of serum VEGF combined with PIVKA-Ⅱ, VEGF combined with AFP, and VEGF combined with AFP and PIVKA-Ⅱ for predicting the clinical efficacy of advanced hepatocellular carcinoma were 0.781, 0.869, and 0.872, respectively (P<0.001) .

Conclusion

TACE combined with targeted immunotherapy can improve the efficacy of patients with advanced hepatocellular carcinoma and prolong the PFS of patients. Serum VEGF in patients can be used as a biological indicator for evaluating clinical efficacy.

Mechanism and in Vitro Experiment of Wogonin in Treatment of Hepatocellular Carcinoma Based on Network Pharmacology

YANG Anyin, LIU Hongli, CHEN Miaoyang, ZHENG Yufeng, XU Zhiyuan, YANG Yongfeng

2024, 27(32):  4040-4049.  DOI: 10.12114/j.issn.1007-9572.2023.0238

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Background

Hepatocellular carcinoma (HCC) is the leading cause of cancer-related deaths. The current prevention and treatment situation remains critical. It is of scientific significance to explore new therapeutic agents for HCC.

Objective

To analyze the mechanism of wogonin on HCC by network pharmacology and to verify it in vitro.

Methods

The drug targets of wogonin were searched in TCMSP database, and the disease targets of HCC were collected from TTD, GenCard, OMIM, DisGent databases. The collected drug targets and disease targets were intersected as potential targets for drug intervention in diseases. R software was used for enrichment analysis of intersection targets, STRING database and Cytoscape software were used to construct protein interaction network and screen core targets. The core targets were further analyzed in GIEPA database. Finally, the preliminary analysis results were verified by in vitro experiments, including cell activity determination using CCK-8 kit, cell proliferation determination using plate clone formation experiment, cell migration determination using scoring test, protein expression level determination using Western-blotting (WB) assay.

Results

The AMDE characteristics of wogonin were found to be in accordance with the rules for small molecule drug formation and the toxicity analysis showed no toxicity. A total of 135 wogonin targets and 8 238 HCC targets were collected, and 113 targets were intersected. Through the analysis of the core genes of TOP10 screened by the constructed protein interaction network, it was found that the mRNA levels of CDK1 and SRC in liver cancer tissues were higher than those in normal liver tissues (P<0.05), and the high expression levels in liver cancer patients were related to poor prognosis (P<0.05). KEGG enrichment analysis showed that the intersection genes were enriched in the PI3K/AKT signaling pathway, and the molecular docking results showed that wogonin had strong binding configuration activity with CDK1 and SRC. The results of CCK-8 kit showed that the activity of HepG2 cells in the 75.0, 150.0, and 300.0 μmol/L wogonin groups was lower than that in the control group (P<0.05). The results of plate clone formation experiment showed that the number of colony formation of HepG2 cells in the 37.5, 75.0, 150.0 μmol/L wogonin groups was lower than that in the control group (P<0.05). The results of scoring test showed that the migration rate of HepG2 cells in the 37.5, 75.0 and 150.0 μmol/L wogonin groups was lower than that in the control group (P<0.05). The results of the WB assay showed that the expression levels of PI3K, P-AKT/AKT, CDK1 and SRC proteins in the 75.0 and 150.0 μmol/L wogonin groups were lower than those in the control group (P<0.05) .

Conclusion

Wogonin inhibits the proliferation and migration of HCC cells and induces apoptosis by down-regulating the expression of CDK1 and SRC proteins and attenuating the PI3K/AKT pathway signaling, to achieve the purpose of interfering with the occurrence and progression of HCC.

Analysis and Identification of Hub Genes in Hepatocellular Carcinoma Based on Weighted Gene Co-expression Network and Cancer Genome Atlas Clinical Data

CHEN Chao, CHEN Tianxiang, LIU Qianwei, ZHANG Zhi, WANG Huanhuan, WU Pingping, GAO Lei, YU Zhaoxiang

2024, 27(32):  4050-4059.  DOI: 10.12114/j.issn.1007-9572.2023.0243

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Background

Hepatocellular carcinoma (HCC) is the third leading cause of common cancer-related mortality globally, accounting for approximately 90% of all primary liver cancer cases. Its recurrence and mortality rates are high, with the underlying molecular mechanisms remaining unclear.

Objective

To explore potential molecular mechanisms of HCC and explore novel biomarkers.

Methods

RNA-seq expression data and clinical information were retrieved from TCGA database, differential gene expression analysis was conducted between normal liver tissue and HCC tissue. Enrichment analysis on the differentially expressed genes was performed. Based on the gene expression data profiles of HCC in TCGA, a co-expression network was established using the WGCNA R package, and weighted gene co-expression network analysis (WGCNA) was performed to select clinically significant modules and screen candidate Hub genes; the candidate Hub genes were further analyzed for significant differential expression in HCC tissues and normal liver tissues, and whether they were significantly correlated with the overall survival and disease-free survival of HCC patients. The Hub genes were conclusively identified, and their protein expression was validated through the Human Protein Atlas database.

Results

The genetic expression data in this study were obtained from 50 normal liver tissue samples and 373 HCC tissue samples. Through differential gene expression analysis, a total of 7 230 genes differential expression between HCC and normal hepatic tissue, comprising 3 691 up-regulated genes and 3 539 down-regulated genes in HCC were identified. Enrichment analysis showed that the up-regulated differentially expressed genes were mainly involved in cell cycle regulation and mitotic processes; the down-regulated differentially expressed genes were mainly involved in processes such as small molecule metabolism and organic acid metabolism. WGCNA identified 19 gene modules related to the clinical features of HCC patients, the cyan and purple modules were screened by analyzing the relationship between the modules and the clinical features. The first two genes in the cyan module genes that were strongly associated with both overall survival and disease-free survival of patients were VPS45 and FAM189B. In the purple module genes, first two genes that were strongly associated with both overall survival and disease-free survival of patients were CLEC1B and FCN3, respectively; therefore, VPS45, FAM189B, CLEC1B and FCN3 were identified as the final Hub genes. Immunohistochemical staining in the Human Protein Atlas database showed that VPS45 and FAM189B were expressed higher in HCC tissues than in normal liver tissues. FCN3 was expressed in HCC tissues lower than in normal liver tissues, the difference in the expression of CLEC1B between HCC tissues and normal liver tissues was not obvious.

Conclusion

VPS45, FAM189B, CLEC1B and FCN3 have been preliminary identified as possible novel potential biomarkers for HCC, which may provide a theoretical basis for targeted therapy of HCC.

Investigating Serum PARP2 as a Potential Diagnostic Biomarker for Hepatocellular Carcinoma

MAIERHABA· Maimaitiaili, ZHANG Kainan, ZHAO Hui, YAKUFU· Tuoheti, YE Jianwei, LYU Guodong

2024, 27(32):  4060-4065.  DOI: 10.12114/j.issn.1007-9572.2023.0553

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Background

Hepatocellular carcinoma (HCC) is the most common malignant liver tumor, with an increasing incidence rate. Since alpha-fetoprotein (AFP), the traditional serum marker for HCC, has a low sensitivity, there is a critical need for novel molecular biomarkers to enable early detection of HCC.

Objective

To detect the protein expression level of serum polyadenosine diphosphate ribose polymerase 2 (PARP2) in HCC patients in the blood of HCC patients and investigate its potential as a diagnostic marker for HCC.

Methods

PARP2 mRNA levels of 50 healthy individuals and 371 HCC patients were analyzed in the TCGA database, and the diagnostic efficacy was analyzed by plotting the receiver operating characteristic (ROC) curve of subjects diagnosed with HCC by PARP2 expression. The levels of PARP2 mRNA and protein expression were assessed in both HCC cells and normal hepatocytes. Serum samples from 38 newly diagnosed HCC patients and 38 healthy individuals undergoing physical examinations at the First Affiliated Hospital of Xinjiang Medical University from March 2021 to July 2022 were collected to measure serum PARP2 protein levels by using the enzyme-linked immunosorbent assay (ELISA) method, and their correlation with HCC clinical characteristics was analyzed. Additionally, the characteristics of serum PARP2 expression levels in diagnosing HCC, particularly in alpha-fetoprotein (AFP) -negative HCC (AFP <20 μg/L) was analyzed, and the efficacy of the combination of serum PARP2 and AFP for the diagnosis of HCC in patients with HCC and healthy individuals was evaluated.

Results

TCGA data showed that PARP2 mRNA expression is higher in malignant tissues compared to paracancerous tissues based on the big data analysis of TCGA (P<0.001). PARP2 mRNA and protein expression levels were higher in HCC cells HepG2 compared to normal hepatocytes WRL68 (P<0.05). HCC patients had higher serum PARP2 protein expression levels compared to healthy individuals (P<0.001). Comparison of serum PARP2 expression levels in those with different lymphatic metastases and tumor counts showed statistically significant differences (P<0.05). The area under the ROC curve (AUC) of serum PARP2 expression level plotted for the diagnosis of HCC was 0.92, with a sensitivity of 76.32%, a specificity of 97.37% and a cut-off value of 19.45 μg/L. Upon serum AFP testing, 21 of the 38 HCC patients were AFP-negative HCC. The AUC of serum PARP2 protein level for diagnosing AFP-negative HCC was 0.95 (95%CI=0.88-1.00), with a sensitivity of 85.71%, a specificity of 97.37%, and a cutoff value of 19.59 μg/L. The diagnostic efficacy of PARP2 in combination with AFP was further evaluated using a "parallel" co-diagnostic approach, the results showed that the diagnostic efficacy of the combined diagnosis of HCC was 92.11%, the specificity was 94.74%, and the AUC was 0.934 2. For AFP-negative HCC patients, the sensitivity of the combined diagnosis was 85.71%, the specificity was 94.74%, and the AUC was 0.902 3.

Conclusion

PARP2 is highly expressed in HCC and can be used as a biological marker for HCC screening, especially in AFP-negative HCC.

Evidence-based Medicine

The Accuracy of Screening for Post-stroke Cognitive Impairment Assessment Tools: a Meta-analysis

MA Yuxia, YANG Yiyi, WEI Xiaoqin, CHEN Yanru, QIN Jiangxia, YUAN Yue, CHEN Yajing, WU Yinping, HAN Lin

2024, 27(32):  4066-4076.  DOI: 10.12114/j.issn.1007-9572.2023.0873

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Background

Post-stroke cognitive impairment (PSCI) brings a heavy burden to patients and their families. An early recognition and intervention can help delay the occurrence and development of PSCI. Therefore, the use of accurate neuropsychological assessment tools to screen for PSCI is essential for the management and treatment of PSCI.

Objective

To analyze the screening accuracy of assessment tools for PSCI by meta-analysis, thus providing references for an accurate screening of PSCI.

Methods

Diagnostic trials on screening tools of PSCI published from the establishment of the database to December 2022 were searched in CNKI, VIP, Wanfang Data, SinoMed, PubMed, Embase, Web of Science, Cochrane Library. Two researchers respectively screened literatures, extracted data, and assessed the risk of bias. Stata 17.0 software was used to analyze the data.

Results

A total of 57 articles were included, involving 7 assessment tools [the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network 5-Minute Battery (NINDS-CSN 5-Minutes), the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Addenbrooke's Cognitive Examination-Revised (ACE-R), the Telephone Interview for Cognitive Status Modified (TICS-m) and the Montreal Cognitive Assessment 5-minute protocol (MoCA-5 min) ] to screen 12 113 patients. Meta-analysis results showed that the combined sensitivity and specificity of MoCA in screening PSCI were 0.84 (95%CI=0.80-0.87) and 0.74 (95%CI=0.67-0.80), respectively, with a combined area under the curve (AUC) of 0.87 (95%CI=0.84-0.90). The combined sensitivity and specificity of MMSE in screening PSCI were 0.73 (95%CI=0.67-0.79) and 0.76 (95%CI=0.69-0.82), respectively, with a combined AUC of 0.81 (95%CI=0.77-0.84). The combined sensitivity and specificity of IQCODE in screening PSCI were 0.73 (95%CI=0.48-0.89) and 0.95 (95%CI=0.75-0.99), respectively, with a combined AUC of 0.91 (95%CI=0.88-0.93). The combined sensitivity and specificity of the NINDS-CSN 5-min in screening PSCI were 0.83 (95%CI=0.78-0.87) and 0.69 (95%CI=0.60-0.76), respectively, with a combined AUC of 0.85 (95%CI=0.81-0.88). The combined sensitivity and specificity of the ACE-R in screening PSCI were 0.90 (95%CI=0.80-0.95) and 0.61 (95%CI=0.19-0.91), respectively, with a combined AUC of 0.90 (95%CI=0.87-0.92). The combined sensitivity and specificity of TICS-m in screening PSCI were 0.84 (95%CI=0.75-0.91) and 0.67 (95%CI=0.61-0.74), respectively, with a combined AUC of 0.66 (95%CI=0.60-0.71) .

Conclusion

The combined AUC of IQCODE and ACE-R is larger, and the former as a higher combined specificity and the latter has a higher combined sensitivity. Therefore, IQCODE and ACE-R are optimal assessment tools to accurately screen PSCI. Due to the limited number of literatures reporting the IQCODE and ACE-R in screening PSCI, our conclusions still need to be validated by multicenter and large-sample studies.

Meta-integration of Qualitative Studies of Hospital to Home Transition Experiences in Patients with Stroke

JIANG Hu, WANG Xiaoxuan, ZHANG Zhenxiang, ZHAO Zhixin, MEI Yongxia, LIN Beilei, WANG Wenna

2024, 27(32):  4077-4084.  DOI: 10.12114/j.issn.1007-9572.2023.0802

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Background

The incidence rate of stroke is high and the risk of recurrence is substantial. Most stroke patients need to transition to home after treatment, and the experience during this period is complex. Therefore, there is an urgent need to comprehensively understand experiences and feelings of patients during hospital to home transition through Meta-integration.

Objective

To systematically evaluate qualitative studies on stroke patients' hospital to home transition experiences.

Methods

A computerized search was undertaken for qualitative studies on the hospital to home transition experience of stroke patients in the PubMed, Web of Science, Scopus, Embase, CINAHL, PsycINFO, CNKI, and Wanfang Data from inception to July 11, 2023. The quality of the final included literature was evaluated using the Joanna Briggs Institute (JBI) Quality Evaluation Criteria for Qualitative Research (2016), Australia, and the results were combined using a pooled integration approach.

Results

A total of 13 studies were included, and 46 findings were distilled and categorized into 7 categories, yielding three final integrative findings: dynamic changes in the physical and psychosocial dimensions have interactive effects; a strong need for holistic caregiving; and active coping with illness and gradual transition to a new life norm.

Conclusion

During the period of transition from hospital to home, stroke patients face complex physical and mental challenges as well as multi-level care needs. Healthcare providers should pay attention to the real experiences and unmet needs of stroke patients throughout the hospital to home transition, provide holistic and continuous care services, and facilitate the comprehensive physical, psychological and social transition for patients.

Review & Perspectives

Progress in Treatment of Post Inflammatory Pulmonary Fibrosis Induced by SARS-CoV-2 Infection

HUANG Lihui, SHU Juan, TAO Huihui, BAO Hairong

2024, 27(32):  4085-4092.  DOI: 10.12114/j.issn.1007-9572.2023.0895

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a major public health emergency in the world, which poses a major threat to the global health system. After rehabilitation from SARS-CoV-2 infection, some patients may experience multiple respiratory symptoms for a long time, which is called the acute sequelae of SARS-CoV-2 infection. Post-COVID-19 pulmonary fibrosis (PCPF) as one of them, can affect the respiratory function and quality of life of patients to varying degrees. Regarding the treatment of PCPF is a hot topic in current research, and this article provides a review of treatment methods for PCPF, aiming to improve the prognosis of PCPF patients.

Perspectives on the Application of Neural Oscillations in the Diagnosis and Treatment of Consciousness Disorders

ZHANG Huimin, SHAN Dawei, ZHANG Yan

2024, 27(32):  4093-4096.  DOI: 10.12114/j.issn.1007-9572.2023.0742

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The diagnosis and treatment of disorder of consciousness (DOC) is still challenging. One of the neural mechanisms of DOC is the destruction of synchronization and connectivity of neural oscillation. This article will review the progress of neural oscillation in the diagnosis and treatment of DOC from three aspects: theoretical basis, application progress, and existing deficiencies of neural oscillations applied to DOC. Neural oscillation is the periodic and synchronous activity of neurons under certain conditions. There are obvious differences in the spectrum characteristics, phase synchronization, and response to neural regulation of neural oscillations among different severities of DOC. The analysis of neural oscillation based on electroencephalography (EEG) reveals the information transmission and processing ability at different levels of consciousness, which is helpful to distinguish different degrees of DOC more accurately and achieve the purpose of DOC wakening treatment by regulating neuro oscillation. Despite there being some problems like insufficient mechanism studies and slow application transformation, neural oscillation has shown great application potential in the diagnosis and treatment of DOC.