Table of Content

20 November 2024, Volume 39 Issue 11

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Incidence and risk factors of postoperative multidrug-resistant bacterial infections in liver transplant patients: A meta-analysis

He Tian, Han Linqiu, Shi Zuxin, Shen Mingyan

2024, 39(11):  965-973.  doi:10.3969/j.issn.1004-583X.2024.11.001

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Objective To identify the incidence and risk factors of postoperative multidrug-resistant bacterial infections in liver transplant patients.Methods A systematic search of the literatures was conducted in the Cochrane Library, CINAHL, Embase, Web of science, Pubmed, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang Data, and CQVIP up to July 2023. Stata16.0 and RevMan5.4 software were used to perform meta-analysis.Results A total of 13 articles representing 5,877 patients were included, and 40 risk factors were extracted. The results of the meta-analysis showed that the combined incidence of postoperative multidrug-resistant bacterial infections in liver transplant patients was 18%, with an incidence ranging from 3% to 48%. The main risk factors included pre-transplant ICU admission (OR=3.71, 95%CI: 2.52-5.46), colonization rate of carbapenem-resistant Acinetobacter baumannii (CRAB) before liver transplant (OR=10.73, 95%CI: 3.79-30.37), the model for End-Stage Liver Disease (MELD) score (OR=5.85, 95%CI: 0.68-11.2), length of post-transplant ICU stay (OR=4.34,95%CI: 2.84-5.84), post-transplant dialysis (OR=2.61, 95%CI: 1.60-4.25), reoperation (OR=4.22, 95%CI: 2.07-8.63), prolonged prothrombin time (OR=1.01, 95%CI: 0.30-1.54), and biliary complications (OR=3.52, 95%CI: 1.98-6.23).Conclusion The incidence of postoperative multidrug-resistant bacterial infections in liver transplantation patients is high. There are many risk factors to be concerned to reduce the incidence of postoperative multidrug-resistant bacterial infections in liver transplantation patients, thus improving the survival.

Meta-analysis of effects of curcumin on inflammation and oxidative stress of patients with type 2 diabetes mellitus

Liang Yi

2024, 39(11):  974-979.  doi:10.3969/j.issn.1004-583X.2024.11.002

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Objective To evaluate the effect of curcumin on inflammation and oxidative stress of patients with type 2 diabetes mellitus(T2DM). Methods Randomized controlled trials (RCTs) of curcumin supplementation for T2DM were collected by searching Pubmed, Embase, Web of science, Cochrane and other databases. Meta-analysis was performed by RevMan5.3 statistical software after data extraction of eligible studies. Results A total of 11 RCTs representing 645 patients were included. The results showed that there was no significant difference in high-sensitive C-reactive protein (hs-CRP) level between the intervention group and the control group after treatment (P=0.07) (SMD=-0.35, 95%CI[-0.73, 0.03], I²=73%). But the total antioxidant capacity (TAC) increased (P<0.001)(SMD=0.47, 95%CI[0.26, 0.68], I²=34%), and the malonaldehyde (MDA) reduced (P=0.03)(MD=-0.48, 95%CI[-0.91, -0.05], I²=90%) significantly in the intervention group compared with the control group. The heterogeneity of studies involved hs-CRP and MDA was great, but subgroup analysis based on age, duration of treatment, and curcumin dose did not found the sources of heterogeneity. Conclusion The curcumin could reduce the oxidative stress and improve the antioxidant capacity of T2DM patients, but it produced no significant effect on inflammation.

Effect of low-level viremia on the incidence of hepatocellular carcinomas in patients with hepatitis B cirrhosis treated with entecavir

Zhang Shasha, Zhao Yingchun, Zhou Hongxia

2024, 39(11):  980-983.  doi:10.3969/j.issn.1004-583X.2024.11.003

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Objective To investigate the effect of low-level viremia (LLV) on the incidence of hepatocellular carcinomas (HCC) in patients with hepatitis B cirrhosis treated with entecavir. Methods A total of 140 patients with hepatitis B cirrhosis admitted from January 2017 to December 2017 and treated with entecavir for more than one year were selected and followed up for five years. According to hepatitis B virus (HBV) DNA detection, patients were divided into LLV group (68 cases) and maintained virological response (MVR) group (72 cases). Factors influencing LLV were observed, and the incidence and mortality of HCC within five years were compared between groups. Results There were significant differences between LLV group and MVR group in age, baseline hepatitis B e antigen (HBeAg) (positive), HBV DNA level and hepatitis B surface antigen (HBsAg) titer before treatment (P<0.05), but no significant differences in gender, body mass index (BMI), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (P>0.05). Binary Logistic regression showed that baseline HBeAg (positive), HBV DNA level and HBsAg titer before treatment were influencing factors for LLV (P<0.05). After five years of follow-up, the incidence of HCC was significantly higher in the LLV group than that of MVR group (23.5% vs 9.7%, P<0.05). The mortality of patients diagnosed with HCC in LLV group was comparable to that of MVR group (43.8% vs 42.8%, P>0.05). Conclusion LLV increases the risk of HCC. Patients with hepatitis B cirrhosis treated with entecavir should be highly concerned, and effective treatment should be adopted to transform LLV into a complete viral response and reduce adverse clinical effects.

Levels of antioxidants and inflammatory factors in female patients with diabetic neurogenic bladder and their clinical significance

Wang Huan, Shen Ting, Kong Yinghong, Ju Yuejun

2024, 39(11):  984-988.  doi:10.3969/j.issn.1004-583X.2024.11.004

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Objective To observe the levels of antioxidant and inflammatory factors in female patients with diabetic neurogenic bladder (DNB) and to analyze their clinical significance. Methods A total of 321 female patients with diabetes mellitus (DM) visited the Endocrinology Department of Affiliated Changshu Hospital of Nantong University from January 2020 to December 2021 were included. They were divided into DNB group and DM group, matched by 1∶3 after passing the tendency score. Plasma levels of antioxidant and inflammatory factors in the matched two groups were analyzed by t-test, and tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), superoxide dismutase (SOD) and glutathione reductase (GR) with P<0.1 were established as logistic regression equations for the dependent variable, and a nomogram was constructed for DNB risk prediction. Plasma levels of TNF-α, IL-6, SOD and GR with unmatched propensity scores were externally verified. Results There were significant differences in disease course, body mass index, hypertension, glycated hemoglobin, creatinine, and total cholesterol between the two groups before matching, and there was no significant differences in baseline data after the preference score after matching the baseline data. There were significant differences in plasma levels of TNF-α in the matched DNB group (47.75±13.04) ng/L and TNF-α (43.18±10.25) ng/L in the matched DM group (P<0.05), while no significant difference was detected in IL-6 level (15.45± 5.78 ng/L vs 13.91±4.62 ng/L, P>0.05). There were significant differences in SOD (56.33±6.53 ng/ml vs 58.75±7.63 ng/ml) and GR (73.93±17.53 ng/L vs 82.18±23.65 ng/L)(P<0.05). Multivariate logistic regression analysis showed that TNF-α, IL-6 and GR were independent risk factors for DNB occurrence (P<0.05). The fit of the regression equation obtained the following statistical data: R^2=0.158, F=4, P=0.0006. External validation of data rows including unmatched samples showed that the area under the curve (AUC) was 0.795(P<0.01). Conclusion In female patients with DNB, plasma antioxidant factors decrease, while inflammatory factors significantly increase. Among them, TNF-α, IL-6, and GR are identified as risk factors for DNB. Additionally, the prediction model established based on these antioxidant and inflammatory factors is able to differentiate DNB to some extent.

Monitoring of blood concentrations of isoniazid and rifampicin in different dosage forms

Wang Lin, Wan Rong, Liu Sha, Liu lei, He Jing, Tang Libin, Li Mingwu

2024, 39(11):  989-992.  doi:10.3969/j.issn.1004-583X.2024.11.005

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Objective To measure blood concentrations of isoniazid (INH) and rifampicin (RFP) in different dosage forms. Methods From July 20, 2022 to November 30, 2022, 123 patients with active tuberculosis hospitalized in the Second Department of Tuberculosis of Kunming Third People's Hospital were included. They were randomly divided into injection group ( n=64) and oral group ( n=59). Both groups were given ethambutol and pyrazinamide. Additionally, the injection group was given RFP injection and INH injection, and the oral group was given RFP capsules and INH tablets. On the 7th day of treatment, blood samples were collected 2 hours and 24 hours after treatment, and the blood concentrations of INH and RFP in the two groups were detected by high performance liquid chromatography.Results There were no significant differences in age, sex, body mass index, treatment history, tuberculosis culture and lesion between the two groups (P>0.05). After 2 hours of medication on the 7th day of treatment, blood concentration of RFP and the proportion of patients with a targeted blood concentration of RFP were significantly higher in the injection group than those of the oral group (P<0.05). The proportions of patients with blood concentration of RFP<8 mg/L and 8-24 mg/L in the injection group was significantly lower than that of the oral group, and the proportion of patients with blood concentration of RFP>24 mg/L was significantly higher than that of the oral group (P<0.05). Multivariate linear regression model analysis showed that age was the influencing factor of blood concentration of INH. The older the age, the lower the blood concentration of INH ( F=7.774, P=0.006).Conclusion The blood concentration of RFP injections is significantly higher than that of oral RFP capsules. For patients with severe or oral treatment of gastrointestinal reactions, RFP injections can be given priority to improve the clinical efficacy. INH is recommended to be given according to body weight, aiming to increase the blood concentration and strengthen the blood concentration monitoring.

Survey of the application and demands of critical care ultrasound in critical illnesses in tertiary hospitals of Sichuan Province

Zeng Xueying, Yin Wanhong, Qin Yao, Wang Yiping, Cao Lianghai, Lei Xianying, Liao Xuelian

2024, 39(11):  993-999.  doi:10.3969/j.issn.1004-583X.2024.11.006

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Objective To investigate the current status of the application of critical care ultrasound in critical illnesses in tertiary hospitals of Sichuan Province, and to provide data reference for subsequent reasonable training, resource allocation, and avoiding incorrect application. Methods Information was collected through the network medium Sojump. Results A total of 166 tertiary hospitals were surveyed, with 22.29% lacking ultrasound instruments applied to critically ill patients. Among 935 medical staff providing healthcare to critically ill patients, 67.38% used ultrasound less frequently (less than 50 cases). In different clinical scenarios, the rate of use ultrasonography in assessing sepsis, shock, cardiopulmonary resuscitation (CPR), deep vein puncture and thoracoabdominal puncture was 63.72%, 56.86%, 54.20%, 57.96% and 73.45%, respectively, all exceeding 50%. More than 80%-90% of healthcare providers believed that the use of critical care ultrasound was able to improve the success rate of puncture in critically ill patients. Similarly, for the management of critical syndromes, the higher the application rate, the higher the rate of change in diagnosis and treatment decisions. Furthermore, the survey revealed that the main challenges currently faced included a shortage of qualified personnel, inadequate equipment availability, insufficient coverage of training courses, and difficulties in interpreting and analyzing critical ultrasound images. Conclusion Although there lacks manpower and resource allocation for ultrasound applications in critically ill patients in Sichuan Province, it is believed to benefit common invasive procedures and assessment of critical syndromes. By investigating the difficulties and needs of application, accurate data references are provided for subsequent reasonable training, resource allocation, thus avoiding erroneous applications.

Summaries from best evidence in brief for management of hyperglycemia after enteral nutrition in patients with severe stroke

Shi Shasha, Ren Haotian, Song Lifei, Li Jiani, Zhou Yan, Zhang Yan

2024, 39(11):  1000-1006.  doi:10.3969/j.issn.1004-583X.2024.11.007

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Objective To search, evaluate and summarize the relevant evidence at home and abroad on the management of hyperglycemia after enteral nutrition (EN) in patients with severe stroke, so as to provide a reference basis for clinical nursing practice. Methods According to the “6S” classification model of evidence-based search resources, literatures related to the management of hyperglycemia after EN in patients with severe stroke were searched in domestic and foreign databases, guideline websites and professional association websites, including guidelines, expert consensus, systematic reviews, evidence summaries and randomized controlled trials. The search time limit was from the establishment of the database to December 12, 2023. Two researchers who have undergone systematic training in evidence-based methodology were independently responsible for literature quality evaluation, data extraction, summary and analysis. Results A total of 15 articles were included, involving 1 randomized controlled trial, 2 systematic reviews, 1 evidence summary, 6 guidelines, and 5 expert consensuses. The overall quality of the literatures was relatively high. From 5 aspects of assessment and screening, blood glucose monitoring and control targets, EN implementation plan, hyperglycemia management, and hypoglycemia management, 28 pieces of evidence were summarized.Conclusion This study summarized the best evidence for the management and prevention of hyperglycemia after EN in patients with severe stroke, which can provide an evidence-based basis for the management of blood glucose related to clinical EN and the standard of nursing quality.

Global research on the microecology in chronic obstructive pulmonary disease from 2014 to 2024: A bibliometric analysis

Zhu Linglong, Huang Weina

2024, 39(11):  1007-1015.  doi:10.3969/j.issn.1004-583X.2024.11.008

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Objective To analyze the global research hotspots and emerging trends in English-language literatures reporting microecology of chronic obstructive pulmonary disease (COPD). Methods Articles reporting microecology of COPD from 2014 to 2024 were searched in the Web of Science Core Collection database. VOSviewer and Citespace tools were employed for co-authorship, co-citation, and co-occurrence analyses of countries, institutions, authors, references, and keywords, which were finally visualized. Results A total of 1, 492 articles were included in the analysis. Overall, there was an annual increase in the publication volume, with the United States leading in the publication output. Dave Singh was identified as the most productive author, while Sanjay Sethi had the highest citation frequency. Int J Chron Obstruct Pulmon Dis was noted as a significant academic publication in this field. Based on the analysis of references and keywords, the lung microbiome and gut microbiome were identified as major research hotspots in the future. Conclusion Microecology research in COPD is flourishing. It is essential for Chinese investigators to enhance international exchanges and cooperation, focusing on prospective clinical studies and the exploration of advanced laboratory techniques.

Maintenance peritoneal dialysis complicated with colon fistula and bladder fistula: A case report and literature review

Xu Ruoyun, Liu Qiong, Jia Minnan, Liu Bing

2024, 39(11):  1016-1020.  doi:10.3969/j.issn.1004-583X.2024.11.009

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Objective To explore the clinical features and treatment of maintenance peritoneal dialysis (MPD) complicated with colon perforation and bladder perforation. Methods The clinical data, diagnosis and treatment of colon perforation and bladder perforation in one MPD patient were retrospectively analyzed, and the literature was reviewed. Results An elderly male presented due to “elevated serum creatinine for 9 years, maintenance peritoneal dialysis for 1 year, and poor catheter function for 5 days”. He was diagnosed with rectal cancer in February 2022 and underwent radical rectal cancer surgery and radiotherapy. After dialysis, peritoneal dialysis (PD) was stopped and changed to regular hemodialysis. In September 2022, he had poor peritoneal dialysis catheter function, and intestinal perforation was considered. He was diagnosed as colon fistula and bladder fistula. His condition was improved after anti-infection treatment, but died of rectal cancer metastasis after discharge. Conclusion For PD patients with intestinal tumor, history of abdominal surgery and radiotherapy, the laparodialysis tube should be removed before operation and hemodialysis should be replaced. When MPD patients have symptoms like abdominal pain, obstruction of catheter drainage, and massive watery diarrhea after infusion of abdominal permeate solution, the occurrence of intestinal perforation should be concerned. Once diagnosed, extubation should be changed to hemodialysis as soon as possible.

Clear cell renal cell carcinoma combined with multiple myeloma: A case report and literature review

Wang Jiaqi, Meng Jianbo, Song Xiaoning, Zhang Jinqiao, Zang Meirong, Lu Jiapei, Suo Jing

2024, 39(11):  1021-1025.  doi:10.3969/j.issn.1004-583X.2024.11.010

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Objective To investigate the clinical features of clear cell renal cell carcinoma (ccRCC) combined with multiple myeloma (MM), and the basis and possibility of co-treatment. Methods The clinical data of one patient in the Hematology Department of Hebei Medical University Third Hospital were analyzed retrospectively.Results A 52-year-old male developed low back pain 2.5 years after the operation of ccRCC, and diagnosed as ccRCC combined with MM by a series examination. Treatment plan incorporated both ccRCC and MM. Induction regimen containing bortezomib and lenalidomide (analogs and upgraded versions of thalidomide) and maintenance therapy with lenalidomide were given, yielding a stable condition of both ccRCC and MM during the follow-up period. Conclusion ccRCC shares a common pathogenic pathway with MM. There may have a basis for the co-treatment of ccRCC and MM.

Effects of cardiac contractility modulation on the autophagy of cardiomyocytes in rabbits with chronic heart failure and the underlying mechanisms

Hao Qingqing, Lv Shilin, Zhang Jing, Zhang Litao, Zhang Feifei

2024, 39(11):  1026-1034.  doi:10.3969/j.issn.1004-583X.2024.11.011

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Objective To explore the effect of cardiac contractility modulation (CCM) on the autophagy of cardiomyocytes in rabbits with chronic heart failure (CHF) and the underlying mechanisms. Methods Thirty healthy New Zealand White rabbits weighing 2.5-3.5 kg were randomly assigned to the sham operation group, HF group, and CCM group, with 10 rabbits in each group. A CHF model was established by the ascending aortic constriction method, followed by CCM for 4 weeks. At 12 and 16 weeks, echocardiography was employed to assess the cardiac function. Expression level of the microtuble-associated protein 1 light chain 3 (LC3) was detected by immunofluorescence staining. Protein levels of P62, Beclin1, light chain 3B II/I (LC3B II/I), protein kinase B (AKT)1, AKT2, AKT3, phosphatidylinositol 3-kinase (PI3K) α110, PI3K α85 and mammalian target of rapamycin (mTOR) in myocardial tissue were detected by Western blot.Results At 12 weeks, rabbits in the HF and CCM groups had significantly larger left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD), and lower left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) than those of sham operation group (P<0.05). At 16 weeks, significant improvements in LVEF, LVFS, LVESD and LVEDD were observed in the CCM group than HF group (P<0.05). Compared with those of the HF group, rabbits in the CCM group had significantly upregulated p62, PI3K α110 and PI3K α85, less LC3-positive immunofluorescence staining, downregulated Beclin1, LC3B, AKT1-3 and mTOR in myocardium and lower LC3B(II/I) ratio (all P<0.05). Conclusion CCM can improve the abnormal expression of LC3B (II/I), Beclin1 and p62 protein in myocardium of CHF rabbits, reduce the activity of autophagy in rabbit myocardium, and improve myocardial contractile and diastolic function by regulating the PI3K/AKT signaling pathway.