Table of Content

15 December 2024, Volume 27 Issue 35

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Guidelines Interpretation

Interpretation of the Use of Artificial Intelligence in Improving Outcomes in Heart Disease：a Scientific Statement from the American Heart Association

ZHOU Yiheng, YANG Ziyu, LYU Yao, LIU Lidi, SHEN Can, LIAO Xiaoyang, JIA Yu

2024, 27(35):  4353-4357.  DOI: 10.12114/j.issn.1007-9572.2024.0192

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Artificial Intelligence (AI) is an emerging technology to improve healthcare services. With the joint promotion of government agencies and academic departments around the world, a large number of studies have demonstrated that AI can improve the diagnosis, treatment and prevention of cardiovascular disease. However, there are still some limitations in its development and application, and it has not yet been widely used in clinical practice. Based on this, the American Heart Association (AHA) published the Use of Artificial Intelligence in Improving Outcomes in Heart Disease: a Scientific Statement from the American Heart Association in Circulation on April 2, 2024. This statement reviews the research progress of AI in the diagnosis, classification and treatment of cardiovascular disease, puts forward the existing problems and potential solutions, and builds a framework for the future application of AI in the cardiovascular disease. This article aims to interpret the statement for providing advice and direction for the application and research of AI in cardiovascular disease in China.

Interpretation of Neighborhoods and Cardiovaseular Health: a Seienifie Statement from the American HeartAssocialion

LYU Yao, LIU Lidi, ZHOU Yiheng, JIA Yu, YANG Ziyu, CHEN Huadong, LIAO Xiaoyang, SHEN Can, LEI Yi

2024, 27(35):  4358-4363.  DOI: 10.12114/j.issn.1007-9572.2024.0333

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Neighborhoods and Cardiovascular Health was drafted by a writing group of experts in cardiology, epidemiology, and preventive medicine and has been published in December 2023 in Circulation: Cardiovascular Quality and Outcomes, the official journal of the American Heart Association (AHA). The American Heart Association provides a roadmap on how to use current knowledge about neighborhoods influence on cardiovascular disease to develop and implement effective interventions to improve cardiovascular health at the population, health system, neighborhoods, and individual levels. Reducing the inequity burden of cardiovascular disease among deprived populations by influencing and improving the neighborhoods environment where possible. Our country is also faced with the problem of imbalance of neighborhoods infrastructure between urban and rural areas as well as between urban and rural areas. The interpretation of this scientific statement may provide new perspectives and ideas for the prevention and control of cardiovascular diseases in China at the community level, which will help to improve the prevention and control of cardiovascular diseases and the cardiovascular health of the public.

Original Research·Research on Health·Sleep Health

Research Progress on Sleep Health

WANG Yanzhe, LIN Zheng, LI Sha, WANG Qingyu, CHENG Hantian

2024, 27(35):  4364-4369.  DOI: 10.12114/j.issn.1007-9572.2024.0175

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Sleep health is a novel concept, a multidimensional sleep-wakefulness pattern that adapts to individual, social, and environmental demands to promote physical and mental well-being. Current research has found that sleep health is not only associated with physiological health issues such as diabetes, overweight/obesity, and cardiovascular risks but also has significant impacts on mental health issues such as anxiety and depression. Previous sleep-related studies have primarily focused on identifying and treating sleep disorders and problems, with less attention to the positive attributes of sleep health. This review summarizes studies on sleep health, including its definition, measurement tools, and correlations with health outcomes, aiming to foster a more comprehensive understanding of sleep health and provide a reference for research on sleep health among Chinese residents.

The Effect of E-aid Brief Behavioral Therapy for Insomnia on Insomnia Disorders

CHEN Pengfei, LIU Yaxi, WANG Tuzhi, ZHANG Guimei, CAI Yixian, PAN Jiyang

2024, 27(35):  4370-4375.  DOI: 10.12114/j.issn.1007-9572.2024.0052

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Background

Insomnia disorder is a common mental health condition that significantly impacts patients' lives and well-being. Traditional cognitive-behavioral therapy for insomnia (CBT-I) is an effective non-pharmacological treatment method, but its complexity, time-consuming nature, and low compliance limit its real-world application. Brief behavioral therapy for insomnia (BBT-I), based on CBT-I principles, offers comparable efficacy while being more suitable for real-world dissemination. However, the applicability of BBT-I to the Chinese population with insomnia disorder remains unclear, and research on BBT-I conducted online is lacking.

Objective

This study aims to investigate the efficacy of online e-aid brief behavioral therapy for insomnia (eBBT-I) delivered via WeChat Mini Program in improving insomnia symptoms among Chinese patients with insomnia disorder. Additionally, the study explores its impact on patients' sleep beliefs and attitudes.

Methods

This study employed a prospective non-randomized controlled design. Insomnia disorder patients from the Sleep Clinic at the First Affiliated Hospital of Jinan University between February and November 2023 were assigned to the intervention group. Insomnia disorder volunteers recruited online and offline were assigned to the control group. The intervention group received a 2-week eBBT-I (e-aid brief behavioral therapy for insomnia) treatment, while the control group received a sham intervention of mental health education. The severity of insomnia was assessed using the Insomnia Severity Index (ISI) and the Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16) questionnaire before and after the intervention to evaluate its effectiveness.

Results

The study ultimately included 35 patients in the intervention group and 30 patients in the control group. Key outcome measures: there was a significant interaction effect between group and time for ISI scores (P<0.05). Group and time separately had significant main effects on ISI scores (P<0.05). No statistically significant difference in ISI scores was observed between the two groups at baseline (pre-intervention) (P>0.05). After 14 days of intervention, the intervention group had lower ISI scores than the control group (P<0.05). Within the intervention group, ISI scores decreased after 14 days compared to baseline (P<0.05). Secondary outcome measures: there was no interaction effect between group and time for DBAS-16 scores (P>0.05). Time had a significant main effect on DBAS-16 scores (P<0.05). Group did not have a significant main effect on DBAS-16 scores (P>0.05). No statistically significant difference in DBAS-16 scores was found between the two groups at baseline or after 14 days (P>0.05). However, within the intervention group, DBAS-16 scores increased after 14 days compared to baseline (P<0.05) .

Conclusion

This indicates that eBBT-I effectively improved insomnia symptoms and negative impact in patients with insomnia disorder, but further improvement in sleep beliefs and attitudes is still needed. This study supports the feasibility and effectiveness of eBBT-I in the treatment of insomnia disorder among Chinese patients.

Effects of Different Exercise Types on Sleep in Insomnia Patients: a Network Meta-analysis

GUO Jia, CAO Chunmei, LIU Guochun, ZHENG Man, ZHU Ruihan, LONG Wei

2024, 27(35):  4376-4387.  DOI: 10.12114/j.issn.1007-9572.2024.0020

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Background

Insomnia not only decreases the quality of life and working efficiency, but also relates to other deceases. Suitable exercises may be useful to improve sleep quality. However, comparative studies on the effects of different types of exercise on sleep outcomes are currently lacked.

Objective

To compare the effects of different exercise types on sleep in insomnia patients and to provide insights for developing exercise prescriptions to improve sleep in this population.

Methods

Randomized controlled trials (RCT) investigating the effects of different types of exercises on the sleep of people with insomnia were retrieved from the PubMed, Web of Science, EBSCO, Scopus, China National Knowledge Infrastructure (CNKI), and Wanfang Data Knowledge Service Platform from database inception to December 2023. The quality of the literatures was assessed using the Jadad scale. A network meta-analysis was performed using the random-effects model of the frequency framework in Stata 17.0 software, and publication bias was observed using a funnel plot.

Results

A total of 36 articles representing 2 706 participants were included in this study. Exercise interventions were categorized into five types, including the aerobic exercise (AE), resistance training (RT), mind-body exercise (ME), prolonged time of exercise (PTE), and AE combined with RT (AE+RT). The results of the network meta-analysis showed that there was a significant difference in the total score of the subjective evaluation tools between AE group and blank control group (SMD=2.20, 95%CI=0.35-4.05, P<0.05). The maximum surface under the cumulative ranking curve (SUCRA) of the total score of the subjective evaluation tools was detected in AE group (82.2%), followed by ME (71.1%), AE+RT (54.2%), RT (38.9%), controlled trial (CT) (29.2%) and PTE groups (24.4%). There was a significant difference in sleep latency (SL) between PTE group versus AE+RT group (SMD=-14.66, 95%CI=-28.60 to -0.72), between AE+RT group versus RT group (SMD=21.32, 95%CI=6.24-36.40), and between AE+RT group versus AE group (SMD=11.19, 95%CI=1.56-20.81) (all P<0.05). The maximum SUCRA of SL was detected in AE+RT group (96.7%), followed by CT (77.1%), ME (49.5%), AE (42.6%), PTE (27.9%) and RT groups (6.1%). There was a significant difference in sleep efficacy (SE) between AE group versus CT group (SMD=4.59, 95%CI=1.59-7.58, P<0.05). The maximum SUCRA of SE was detected in the AE group (83.1%), followed by AE+RT (59.9%), RT (50.7%), ME (46.9%), PTE (35.5%) and CT groups (23.9%). There was a significant difference in wake time after sleep onset (WASO) between PTE group versus RT group (SMD=23.39, 95%CI=14.67-32.02), between PTE group versus AE group (SMD=14.86, 95%CI=4.64-36.40), between PTE group versus CT group (SMD=12.11, 95%CI=7.62-16.59), between RT group versus ME group (SMD=-27.61, 95%CI=-40.49 to -14.73), between RT group versus CT group (SMD=-11.28, 95%CI=-20.86 to -1.70), between ME group versus AE group (SMD=19.08, 95%CI=5.18-32.98), and between ME group versus CT group (SMD=16.33, 95%CI=7.26-25.40) (all P<0.05). The maximum SUCRA of WASO was detected in the RT group (94.7%), followed by CT (80.2%), AE (41.8%), ME (31.5%) and PTE groups (1.7%). There was a significant difference in the total sleep time (TST) between RT group versus AE group (SMD=-20.84, 95%CI=-38.46 to -3.23), between AE group versus CT group (SMD=12.02, 95%CI=2.96-21.08) (all P<0.05). The maximum SUCRA of TST was detected in the AE group (87.2%), followed by AE+CT (71.6%), PTE (53.8%), ME (40.6%), CT (35.9%) and RT groups (10.8%). There was no significant difference in the sleep quality (SQ) among groups (P>0.05). The maximum SUCRA of SQ was detected in the AE group (84.2%), followed by AE+CT (75.5%), ME (24.9%) and CT groups (15.4%). Publication bias analysis of the total score of subjective evaluation tools, SL, SE, WASO, TST, and SQ revealed some asymmetry in all six outcome indicators, indicating a certain risk of publication bias.

Conclusion

Given the favorable effects of AE on multiple sleep parameters, we recommend insomnia patients engage in moderate-intensity AE, such as jogging or brisk walking, three times a week for approximately 30 minutes. Additionally, options include moderate-intensity RT or AE+RT four to five times a week. When engaging in the above exercises, attention should be paid to the choice of time period, and exercise within 3 hours before bedtime should be avoided as much as possible.

Advance in Evaluation of the Clinical Efficacy of Non-benzodiazepine Drugs in Treating Comorbid Insomnia and Sleep Apnea

DONG Menglong, LIN Zhifeng, FAN Mengmeng, XUE Shengwen, LIU Yuhang, WANG Yi, CHENG Jinxiang

2024, 27(35):  4388-4396.  DOI: 10.12114/j.issn.1007-9572.2024.0133

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Comorbid insomnia and sleep apnea is a highly prevalent disorder characterized by both insomnia and sleep apnea, leading to more severe impairment of daytime function and quality of life than in patients with either insomnia or obstructive sleep apnea (OSA) alone. Non-benzodiazepine drugs (NBZDs) are frontline medications for insomnia treatment, as they can improve insomnia symptoms and enhance sleep quality. However, they are not recommended for OSA treatment due to their potential to increase the apnea-hypopnea index (AHI) and worsen the severity of sleep-disordered breathing. Currently, the therapeutic effects of NBZDs on COMISA are not well-established and require further investigation. Therefore, this article adopts a systematic review approach to compile relevant literature on the use of NBZDs in patients with OSA and COMISA, analyzing the impact of NBZDs on various indicators such as AHI, oxygen desaturation index, and sleep quality. It evaluates the clinical efficacy and safety of medications including zopiclone, eszopiclone, zolpidem, and zaleplon in the treatment of COMISA, aiming to provide guidance on the rational use of NBZDs for these patients.

Original Research

Combined Predictive Value of Neutrophil-to-lymphocyte Ratio and C-reactive Protein-to-albumin Ratio for All-cause Mortality Risk in Patients with Maintenance Hemodialysis: Cohort Study Followed for 5 Years

CHEN Ruman, BAI Yafei, WANG Chunli, AN Na, XU Mingzhi, HE Jiqing, QI Yonghui, WANG Liheng, LI Hong

2024, 27(35):  4397-4402.  DOI: 10.12114/j.issn.1007-9572.2024.0068

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Background

Neutrophil-to-lymphocyte ratio (NLR) has been shown to have significant predictive value for all-cause mortality risk in patients with maintenance hemodialysis (MHD) in previous studies, however, whether C-reactive protein-to-albumin ratio (CAR) and the combination of NLR and CAR can enhance the predictive value for all-cause mortality risk in patients with MHD has not been investigated.

Objective

To investigate the combined predictive value of NLR and CAR for all-cause mortality of MHD patients, and to provide evidence for improving the quality of life of MHD patients.

Methods

The case data of 175 MHD patients in the Blood Purification Center of Hainan General Hospital in January 2017 were included, the deadline was December 31, 2021, with the outcome of all-cause death. Receiver operating characteristic (ROC) curves were plotted for the predictive value of NLR+CAR, NLR, and CAR for the risk of all-cause death in MHD patients. Kaplan-Meier survival curve was used to compare the cumulative survival rate between the two groups. Cox regression analysis was used to analyze the independent risk factors of 5-year all-cause death in MHD patients.

Results

The area under the ROC curve (AUC) of NLR for predicting the risk of all-cause death in MHD patients was 0.743 (95%CI=0.669-0.817, P<0.001). The AUC of CAR for predicting the risk of all-cause death in MHD patients was 0.710 (95%CI=0.627-0.794, P<0.001). The AUC of NLR+CAR for predicting the risk of all-cause death in MHD patients was 0.799 (95%CI=0.732-0.867, P<0.001). Kaplan-Meier survival curve analysis showed that patients with NLR>4.93 had lower cumulative survival than patients with NLR ≤4.93 (χ²=32.753, P<0.001). The patients with CAR>0.795 had a lower cumulative survival than patients with CAR≤0.795 (χ²=38.091, P<0.001). According to the results of the multiple Cox regression equation, dialysis age (HR=0.984, 95%CI=0.976-0.992), ferritin (HR=0.984, 95%CI=0.976-0.992), 25- (OH) D (HR=0.964, 95%CI=0.941-0.987) and triglyceride (HR=0.984, 95%CI=0.976-0.992) were protective factors for all-cause mortality in 5-year MHD patients; NLR>4.93 (HR=2.071, 95%CI=1.226-3.499) and CAR>0.795 (HR=1.903, 95%CI=1.155-3.136) were independent risk factors for all-cause death in 5-year MHD patients (P<0.05) .

Conclusion

Compared with NLR or CAR alone, the combination of NLR and CAR can better predict the risk of all-cause mortality in MHD patients. Increased NLR and CAR were independent risk factors for all-cause mortality in 5-year MHD patients.

Comparison of the Diagnostic Value of Calf Circumference, Upper Arm Circumference and Ishii Score in Patients with Coronary Heart Disease Complicated with Sarcopenia

LUO Qin, GOU Lianping, CHEN Yin, SU Feng

2024, 27(35):  4403-4411.  DOI: 10.12114/j.issn.1007-9572.2023.0441

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Background

As a common geriatric chronic disease, sarcopenia has a high prevalence in patients with coronary heart disease (CHD), which increases the risk of adverse events such as falls and fractures, calf circumference, upper arm circumference, and Ishii score have been shown to be valuable in screening for sarcopenia, but are less commonly used in CHD patients.

Objective

To evaluate the accuracy and consistency of calf circumference, upper arm circumference, and Ishii score in screening for combined sarcopenia in hospitalized elderly patients with CHD.

Methods

A total of 213 CHD patients treated at the Department of Cardiology, Affiliated Hospital of North Sichuan Medical College from January 1, 2023 to May 31, 2023, were selected for the study, the body composition test instrument was used to detect indicators such as muscle mass and upper arm circumference, the measurement of calf circumference was performed, and Ishii score was calculated simultaneously. Spearman's rank correlation analysis was used to explore the correlation of upper arm circumference, calf circumference and Ishii score with indicators such as muscle mass, the diagnostic effect of upper arm circumference, calf circumference and Ishii score on sarcopenia in different people was analyzed by plotting receiver operating characteristic (ROC) curves, and the optimal diagnostic cut-off values were determined, which were calculated as Kappa values to determine the consistency of the upper arm circumference, calf circumference and Ishii score with the diagnostic criteria of sarcopenia according to the Chinese Expert Consensus (2023) Criteria for the Prevention and Treatment of Sarcopenia in the elderly.

Results

The prevalence of combined sarcopenia in CHD patients was 27.2% (58/213). In the whole population, upper arm circumference and calf circumference was positively correlated with appendicular skeletal muscle mass, appendicular skeletal muscle mass index, and grip strength (P<0.001), while Ishii score was negatively correlated with appendicular skeletal muscle mass, appendicular skeletal muscle mass index, and grip strength (P<0.001). In males, upper arm circumference and calf circumference was positively correlated with appendicular skeletal muscle mass, appendicular skeletal muscle mass index, and grip strength (P<0.001), while Ishii score was negatively correlated with appendicular skeletal muscle mass, appendicular skeletal muscle mass index, and grip strength (P<0.001). In females, upper arm circumference and calf circumference was positively correlated with appendicular skeletal muscle mass, appendicular skeletal muscle mass index, and grip strength (P<0.001), while Ishii score was negatively correlated with appendicular skeletal muscle mass, appendicular skeletal muscle mass index, and grip strength (P<0.001). ROC curve showed that the optimal cut-off value of calf circumference for the diagnosis of sarcopenia in males was 34.3 cm (sensitivity=86.5%, specificity=64.6%) ; the optimal cut-off value of calf circumference for the diagnosis of sarcopenia in females was 33.8 cm (sensitivity=100.0%, specificity=50.0%) ; the optimal cut-off value for upper arm circumference to diagnose sarcopenia in males was 28.0 cm (sensitivity=70.3%, specificity=85.9%) ; the optimal cut-off value for upper arm circumference diagnosis of sarcopenia in women was 27.5 cm (sensitivity=81.0%, specificity=69.6%) ; the optimal cut-off value of Ishii score for the diagnosis of sarcopenia in males was 114.07 points (sensitivity=91.9%, specificity=62.6%) ; the optimal cut-off value of Ishii score for the diagnosis of sarcopenia in females was 120.08 points (sensitivity=100.0%, specificity=64.3%). The concordance of indicators with the diagnostic criteria was good, except for low concordance (Kappa=0.353) between calf circumference in women and the diagnostic criteria for sarcopenia in Chinese Expert Consensus (2023) Criteria for the Prevention and Treatment of Sarcopenia in the elderly.

Conclusion

In hospitalized elderly patients with CHD, both upper arm circumference and calf circumference are positively correlated with muscle mass, and Ishii score is negatively correlated with muscle mass, and all three indicators are effective in screening for sarcopenia. However, this study recommends Ishii score for screening of sarcopenia and early preventive interventions by medical staff.

Study on Risk Prediction of Non-dementia Vascular Cognitive Impairment in Glycolipid Metabolic Diseases

GU Shanye, ZHOU Ziyi, CAI Yefeng

2024, 27(35):  4412-4416.  DOI: 10.12114/j.issn.1007-9572.2024.0122

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Background

With the aging population in China, the incidence of vascular cognitive impairment (VCI) will increase year by year. Non-dementia vascular cognitive impairment (VCIND) is the most common form of VCI. At present, the research shows that glycolipid metabolic diseases will accelerate the process of VCI, and the treatment of VCI focuses on controlling risk factors, but there is a lack of relevant research on VCIND caused by glycolipid metabolic diseases.

Objective

To analyze the factors influencing the occurrence of VCIND with glycolipid metabolic disease, construct a regression model, and conduct risk prediction.

Methods

A total of 410 patients with glycolipid metabolic diseases who were hospitalized in the encephalopathy center of Guangdong Provincial Hospital of Traditional Chinese Medicine from March to December 2023 were selected. Patients were divided into a cognitive normal group (MMSE>26 points) and a VCIND group (MMSE≤26 points) according to the Mini-mental State Examination Scale (MMSE). Multivariate Logistic regression was used to evaluate the influencing factors of VCIND in middle-aged and elderly patients with glycolipid metabolic diseases, and the risk prediction model of VCIND in glycolipid metabolic diseases was constructed. The predictive value of the model was evaluated via the receiver's operating characteristic (ROC) curve, and the area under the ROC curve (AUC) was calculated.

Results

Among the 410 patients, there were 209 cases in the cognitively normal group and 201 cases in VCIND. The results of multivariate Logistic regression analysis showed that low education level [below primary school (OR=25.989, 95%CI=5.656-119.427), primary school (OR=6.839, 95%CI=3.919-11.933) ], Fazekas grade (OR=1.700, 95%CI=1.124-2.570) were independent influencing factors for the occurrence of VCIND in patients with glycolipid metabolism (P<0.05). Based on the results of multivariate Logistic regression analysis, the prediction model was logit (P) =-1.608+ primary school×1.923+ below primary school×3.285+Fazekas grading×0.531. The AUC of this risk prediction regression model was 0.767 (95%CI=0.721-0.813, P<0.001). Hosmer-Lemeshow goodness-of-fit test showed that the model has a good fitting effect (χ²=13.404, P=0.099) .

Conclusion

Low literacy and Fazekas classification are independent influencing factors for the development of VCIND in a population of patients with glycolipid metabolism. Establishing a risk prediction regression model based on the above risk factors has a good predictive value and helps to identify the high-risk group of developing VCIND in patients with glycolipid metabolism disease at an early stage.

Clinical Predictive Value of Immature Platelet Fraction Combined with Other Biomarkers for the Severity and Prognosis of Sepsis

ZHANG Lianfang, ZHENG Yabin, LIN Xuefeng, XIE Rongcheng, MA Jiefei

2024, 27(35):  4417-4425.  DOI: 10.12114/j.issn.1007-9572.2023.0776

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Background

Sepsis is a systemic inflammatory response caused by an imbalance of the host immune response to infectious factors, potentially leading to life-threatening organ dysfunction. The application of immature platelet fraction (IPF) to assessing the severity and prognosis of sepsis has been previously analyzed. However, the application of IPF combined with other biomarkers to predict sepsis has been rarely reported.

Objective

To explore the predictive value of IPF combined with other biomarkers in the severity and prognosis of sepsis.

Methods

A total of 60 sepsis patients admitted to the Department of Critical Care Medicine, Zhongshan Hospital, Fudan University (Xiamen Branch) from November 2020 to November 2022 were retrospectively recruited for analyzing their clinical data. Patients were classified into the severe sepsis group (n=24) and septic shock group (n=36) based on the severity of sepsis. Divided by the Sequential Organ Failure Assessment (SOFA) score, 60 sepsis patients were assigned into the low SOFA group (SOFA score<6 points, n=26) and high SOFA group (SOFA score ≥6 points, n=34). According to the outcome, there were 39 cases in the survival group and 21 cases in the death group. IPF and other blood indicators, including neutrophil to albumin ratio (NAR), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), and lactate to albumin ratio (LAR) were compared. The receiver operating characteristic (ROC) curves of IPF combined with other biomarkers for predicting the severity and prognosis of sepsis were plotted, and the area under the curve (AUC) was calculated.

Results

The proportion of lung diseases, baseline Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores and baseline SOFA scores were significantly higher in the death group compared to those of the survival group (P<0.05). Similarly, the proportion of lung diseases, baseline APACHE II scores and mortality were significantly higher in the high SOFA group compared to those of the low SOFA group (P<0.05). IPF at 48 hours of treatment was significantly higher in the septic shock group than that of the severe sepsis group, which was significantly higher in the high SOFA group compared to that of the low SOFA group, and significantly higher in the death group compared to that of the survival group (P<0.05). Given the significant difference in 48 h IPF between groups, the laboratory indicators at this time point were selected for further research and analysis. The AUC of IPF in predicting septic shock, a high SOFA score and death was 0.70 (95%CI=0.55 to 0.83, cut-off value 3.95%) and 0.72 (95%CI=0.60 to 0.86, cut-off value 7.70%), 0.73 (95%CI=0.58 to 0.89, cut-off value 6.10%), respectively. The AUC of IPF + baseline APACHE Ⅱscore + NLR, and IPF + baseline APACHE Ⅱ score + LAR in predicting a high SOFA score was 0.91 (95%CI=0.84 to 0.98) and 0.93 (95%CI=0.84 to 0.99), respectively. The AUC of IPF + NAR + PLR in predicting the death in sepsis patients was 0.90 (95%CI=0.81 to 0.98) .

Conclusion

IPF combined with different blood indicators can improve the ability to assess the severity and prognosis of sepsis in clinical practice. Specifically, 48 h IPF + baseline APACHE Ⅱ score+48 h NLR and 48 h IPF + baseline APACHE Ⅱscore+48 h LAR have high efficacy in predicting the severity of sepsis; whereas 48 h IPF+NAR+PLR shows a superior efficacy in predicting the prognosis of sepsis.

Research on the First-line Efficacy of EGFR-TKIs and Chemotherapy in EGFR Non-hotspot Mutated Non-small Cell Lung Cancer

TAN Zirui, SHEN Qing, LIU Junying, CHEN Yanning, YAO Jifang

2024, 27(35):  4426-4434.  DOI: 10.12114/j.issn.1007-9572.2024.0256

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Background

Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are one of the individualized targeted therapeutic options for patients with advanced EGFR mutated non-small cell lung cancer (NSCLC), which can significantly improve the prognosis. However, the response to TKIs changed variously depends on different type of EGFR mutations.

Objective

To explore the efficacy of EGFR-TKIs versus chemotherapy in EGFR non-hotspot mutated non-small cell lung cancer patients.

Methods

Ninety patients with postoperative recurrent or advanced NSCLC during April 2012 to June 2019 were collected from the Fourth Hospital of Hebei Medical University, of whom were confirmed with EGFR non-hotspot mutations. Patients were divided into first-line EGFR-TKIs treatment group and first-line chemotherapy group depended on first-line treatments. All patients were followed up by telephone or by reviewing in-patient and out-patient cases to obtain their prognosis information. The deadline for follow-up was March 31, 2024. The curative effect, progression-free survival (PFS) and overall survival (OS) were observed.

Results

Among 90 patients, there were 52 cases in EGFR-TKIs treatment group and 38 cases in first-line chemotherapy group. There were 16 patients with postoperative recurrence and metastasis, and 74 patients with initial stage ⅢB-Ⅳ diagnosis. Among the patients with EGFR non-hotspot mutations, there were 51 cases of single gene mutation and 39 cases of compound mutations. After progression of first-line EGFR-TKIs treatment, there were 8 patients treated with EGFR-TKIs and 9 patients treated with chemotherapy. After progression of first-line chemotherapy, 8 patients were treated with EGFR-TKIs, 16 patients with chemotherapy and 1 patient with immunotherapy. The PFS of patients with different subtypes of EGFR non-hotspot mutations who received first-line EGFR-TKIs treatment was statistically significant (χ²=24.26, P<0.001). Compared with the first-line chemotherapy group, PFS and OS in the first-line EGFR-TKIs treatment group were significantly different (P<0.05). Among the patients with single mutation, there was significant difference in PFS and OS between the first-line EGFR-TKIs treatment group and the first-line chemotherapy group (P<0.05). Among the patients with compound mutation, there was significant difference in PFS between the irst-line EGFR-TKIs treatment group and the first-line chemotherapy group (P<0.05). There was no significant difference in OS between the first-line EGFR-TKIs treatment group and the first-line chemotherapy group (P>0.05). Among the patients after progression of first-line chemotherapy, the median PFS of second-line EGFR-TKIs treatment (8 cases) and chemotherapy (16 cases) was 11.3 months and 5.6 months, respectively. There was a significant difference of PFS between second-line EGFR-TKIs treatment group and chemotherapy group (χ²=7.487, P=0.006) .

Conclusion

In postoperative recurrent or advanced NSCLC with non-hotspot EGFR mutations, there was a difference in survival between patients with EGFR ex20ins and E20 S768I mutations and patients with other mutation types treated with first-line EGFR-TKIs treatment. However, in all mutation, treatment with first-line EGFR-TKIs significantly prolonged patient survival compared with first-line chemotherapy.

Original Research·Appropriate Technology

Application of Vestibular Function Combined with Audiological Examination in Vertigo Diseases

HU Zhen, LIU Mei, GONG Limei, WANG Jianhong

2024, 27(35):  4435-4438.  DOI: 10.12114/j.issn.1007-9572.2023.0845

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Background

There are many types of vestibular function examination, each with different targets and positive rates. Clinical opinions vary on how to appropriately select examination methods for vertigo patients.

Objective

To explore the application value of vestibular function combined with audiological examination in peripheral vertigo diseases, and provide a reference basis for the diagnosis and differential diagnosis of clinical vertigo diseases.

Methods

Patients with dizziness or vertigo as the main complaint were selected from January 2021 to January 2022 in the Vertigo Clinic of the First People's Hospital of Yibin. All patients finished the examination within 7 days including pure tone audiometry (PTA), caloric test, video head impulse test (vHIT) and head-shaking test (HST). The vestibular function examination and audiological examination results were compared.

Results

A total of 120 patients with vertigo who met the inclusion and exclusion criteria had complete case data, there were 40 cases of sudden deafness with vertigo (SDV), benign paroxysmal positional vertigo (BPPV), and vestibular migraine (VM). The PTA in SDV patients was sensorineural deafness, 25 cases with caloric test abnormalities (62.50%), 16 cases with vHIT abnormalities (40.00%), 28 cases with HST abnormalities (70.00%). Nine BPPV patients had PTA abnormalities (22.50%), including 7 ears with sensorineural deafness, 2 ears with conduction deafness, 18 cases with caloric test abnormalities (45.00%), 21 cases with vHIT abnormalities (52.50%), and 20 cases with HST abnormalities (50.00%). There were 21 cases (52.50%) of PTA abnormalities in VM patients, all with sensorineural deafness, of which 26 ears had high-frequency hearing-light-moderate decline and 7 ears had low-frequency light-moderate decline. There were 16 cases with caloric test abnormalities (40.00%), 17 cases with vHIT abnormalities (42.50%), and 27 cases with HST abnormalities (67.50%). The proportion of hearing abnormalities in the three groups was statistically significant difference (χ²=50.26, P<0.001), and there were no statistically significant difference among the results of vestibular function examination (P>0.05) .

Conclusion

The vestibular function combined with audiological examination is helpful to the localization diagnosis of peripheral vertigo and to improve the detection rate and differential diagnosis of vertigo diseases.

The Value of Cardiac 3-Dimensional Computed Tomography in the Simplified Left Atrial Appendage Occlusion

CHENG Cheng, DU Weiwei, HE Fei, SHENG Jianlong, HUANG Zheng, WANG Xiaochen

2024, 27(35):  4439-4445.  DOI: 10.12114/j.issn.1007-9572.2024.0091

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Background

Simplified left atrial appendage occlusion (LAAO) is one of the important treatment methods for preventing thromboembolism in patients with nonvalvular atrial fibrillation. Currently, there are few studies on the value of cardiac 3-dimensional computed tomography (3D-CT) in the simplified LAAO.

Objective

To investigate the feasibility, safety, surgical efficacy and postoperative follow-up value of 3D-CT in simplified LAAO.

Methods

We prospectively recruited 52 patients who underwent simplified LAAO in the Second Affiliated Hospital of Anhui Medical University from May 2021 to January 2024. They were randomly assigned into the control group and study group by lottery. Preoperative transesophageal echocardiography (TEE) and preoperative cardiac 3D-CT were performed in the control group and study group, respectively. The baseline data, maximum ostium diameter and maximum depth of the left atrial appendage (LAA), match rate between the delivered sheath and the axis of LAA, operation time, time for x-ray exposure and dose, consumption of contrast agent, the rate of non-recapture and non-change of occlusion device, peri-device leakage (PDL), and perioperative complications were collected. A 3D-CT follow-up was performed for 90 days after LAAO.

Results

Both the control group and the study group comprised 26 cases each, using the WATCHMAN device for LAAO, with no serious perioperative complications. Preoperative examinations showed no intracardiac thrombus in all patients. In the control group, the maximum ostium diameter of the LAA measured by preoperative TEE and intraoperative DSA was (22.9±4.1) mm and (25.4±2.9) mm, respectively, not showing a positive correlation (r=0.374, P=0.060). The usable depth of the LAA in the control group measured by preoperative TEE and intraoperative DSA was (25.7±8.1) mm and (23.7±3.4) mm, respectively, showing a positive correlation (r=0.392, P=0.048). In the study group, the maximum ostium diameter of the LAA measured by preoperative 3D-CT and intraoperative DSA was (25.0±3.3) mm and (24.9±5.8) mm, respectively, showing a positive correlation (r=0.566, P=0.003). The usable depth of the LAA in the study group measured by preoperative 3D-CT and intraoperative DSA was (23.5±4.2) mm and (23.1±4.0) mm, respectively, showing a positive correlation (r=0.774, P<0.001). The match rate between the delivered sheath and the axis of LAA was significantly higher in the study group than that of control group (96.2%, n=25; 76.9%, n=20; χ²=4.172, P=0.042). Patients in the study group had significantly shorter atrial septal puncture time, occlusion time, and exposure time to X-ray, and lower X-ray dose and consumption of contrast agent compared to those of the control group (P<0.05). The incidence of intraoperative minor PDL in the study group was significantly lower than that in the control group (P<0.05). A total of 37 patients, with 16 cases in the control group and 21 in the study group, completed the 90-day follow-up after LAAO. No device-related thrombus (DRT) or PDL larger than 5 mm was found, and incomplete device endothelialization was observed in some patients.

Conclusion

Reoperative cardiac 3D-CT in simplified LAAO benefits a shorter operation time, shorter fluoroscopy time, less dosage to X-ray exposure, and lower rate of minor PDL. It also demonstrates certain advantages of detecting incomplete endothelialization in postoperative follow-up. With the advancement of 3D-CT in the application of LAAO, it can be combined with 3D printing technology in the future to simulate the procedural process accurately, making LAAO safer and more efficient.

Review & Perspectives

Research Progress and Prospects of Internet of Things Technology in Chronic Obstructive Pulmonary Disease Management

PAN Zihan, LI Shurun, CHEN Yahong

2024, 27(35):  4446-4454.  DOI: 10.12114/j.issn.1007-9572.2023.0355

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In recent years, the Internet of Things technology (IoT) has been developed extremely rapidly, and has been widely applied in the medicine field. Chronic obstructive pulmonary disease (COPD) is one of the most common chronic respiratory diseases in China, and it is worth exploring how IoT can be used to improve the clinical practice of COPD management. We summarized the research progress of IoT technology in COPD management at home and abroad and found that the current research on the application of IoT in COPD management is still in the exploratory stage and lacks high-quality, large-sample studies by reviewing the literature. Real-world studies are needed to conduct systematic evaluation of designed mature models or products in the future, especially the impacts on long-term clinical outcomes of patients, quality of life and health economics evaluation. Products design should be tailored to the characteristics and target of COPD and the characteristics of users, and emphasis should also be placed on qualitative researches to understand the experiences, opinions or attitudes of users toward such products.

Advances in Gut Microbiota in Heart Failure Combined with Depression

HUANG Kai, ZHANG Yi, YANG Chun, YANG Ling

2024, 27(35):  4455-4461.  DOI: 10.12114/j.issn.1007-9572.2023.0638

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Heart failure patients are prone to depression, and interact with each other, leading to lower quality of life and poor prognosis of patients. As the largest microecosystem in the human body, changes in the composition, structure and function of the gut microbiota are closely related to the physiological and pathological states of the host. Currently, the "gut-heart/brain axis" has been used to explain the link between gut microbiota, cardiovascular diseases, and mood states, which is an important comorbid basis for heart failure and depression. In this paper, we reviewed the mechanisms of gut microbiota, metabolites, and vagus nerve in the development of heart failure and depression, and propose that mediterranean diet, probiotics, and microbiota transplantation have the potential to improve the "microbiota-gut-heart/brain axis", providing a new perspective for the treatment of heart failure patients comorbid with depression.

Research Progress on the Mechanism of Immune Imbalance in the Pathogenesis of IBS-D and Chinese Medicine Intervention

MEI Xiao, PAN Haidi, WU Xiaorui, HE Changhui, DOU Xin, DENG Hualiang, WANG Wei

2024, 27(35):  4462-4467.  DOI: 10.12114/j.issn.1007-9572.2023.0835

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Diarrhea-predominant irritable bowel syndrome (IBS-D) is a clinically common functional gastrointestinal disease, in which immune imbalance plays an important role. Related immune cells include innate immune cells and adaptive immune cells, and immune cytokines include immunoglobulin, interferon, interleukin, tumor necrosis factor, etc. Traditional Chinese medicine monomers/compounds or compound formulas can regulate immunotherapy for IBS-D through multi-pathway, multi-target. This article systematically reviews and sorts out relevant literature on targeted immunotherapy of IBS-D using traditional Chinese medicine monomers/compounds and compound therapies from the perspectives of immune imbalance and intestinal infection, dysbiosis of flora, brain-gut axis disorder, and endocrine disorders. At the same time, it confirms the similarities between the "spleen as the guard" and immunity, to provide ideas for traditional Chinese medicine to treat IBS-D and related diseases through immune-mediated pathways.