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Clinical Focus    2022, 37 (7): 653-657.   DOI: 10.3969/j.issn.1004-583X.2022.07.014 Abstract （1365）   HTML （2）    PDF（pc） （886KB）（361）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Standardized detection of BCR-ABL mRNA and clinical application in patients with chronic myeloid leukemia Qin Yazhen Clinical Focus    2021, 36 (10): 884-888.   DOI: 10.3969/j.issn.1004-583X.2021.10.004 Abstract （1258）   HTML （8）    PDF（pc） （435KB）（213）       Knowledge map    Save BCR-ABL mRNA is the molecular marker of chronic myeloid leukemia(CML), and tyrosine kinase inhibitors(TKIs) targeting BCR-ABL mRNA has become the basic drug for CML. BCR-ABL mRNA level is the important indicator for evaluation of TKI efficacy. The mutation in ABL tyrosine kinase domain suggests mechanism of TKI resistance, which could guide the treatment strategy such as the selection of next TKIs. Standardized detection of BCR-ABLmRNA is essential for precisely guiding treatment and the guarantee for CML patients to achieve the best curative effects. Standardization is involved in sample type, testing content, laboratory protocol and report ways. This paper explored the standardized detection of quantification and mutation of BCR-ABL and clinical application in CML patients based on recent literature. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Flow cytometry in minimal residual disease detection of acute myeloid leukemia: current status and progress Wang Hui, Chen Man Clinical Focus    2021, 36 (10): 889-895.   DOI: 10.3969/j.issn.1004-583X.2021.10.005 Abstract （1249）   HTML （1）    PDF（pc） （1466KB）（219）       Knowledge map    Save Minimal residual disease(MRD) of acute myeloid leukemia (AML) detected by flow cytometry(FCM) has high sensitivity and coverage, which has been an important biomarker for efficacy evaluation, outcome prediction, and therapy selection. However, a number of questions remain uncertain. This paper introduced the status and problems of FCM detection in AML MRD, discussed the corresponding solutions and precautions with the new hope by the progress of FCM. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Diagnosis and treatment of adult Langerhans cell histiocytosis Cao Xinxin Clinical Focus    2021, 36 (10): 905-909.   DOI: 10.3969/j.issn.1004-583X.2021.10.008 Abstract （1196）   HTML （1）    PDF（pc） （682KB）（139）       Knowledge map    Save Langerhans cell histiocytosis(LCH) is an inflammatory myeloid malignancies with MAPK pathway activation mutations detectable in nearly all patients and a pronounced inflammatory state. The clinical manifestations of LCH are diversity, the most common involved organs included Bones, lungs, pituitary, ect. The primary diagnosis of LCH depends on histopathologic review of lesional tissue biopsy; the gold standard for diagnosis were expression of Cd207 (Langerlin) in immunohistochemistry and birbeck granules(BGs) by electron microscopy. LCH can be devided into localized single-system disease(SS-s), multiple sites within one single system (SS-m), and multisystem(MS) disease according to the scope of clinically involved organs. In terms of clinical classification, Local therapies may be sufficient for SS-s patients, systemic therapies might be better for SS-m or MS patients. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2022, 37 (1): 77-80.   DOI: 10.3969/j.issn.1004-583X.2022.01.015 Abstract （1128）   HTML （1）    PDF（pc） （894KB）（229）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Coffin-siris syndrome: A case literature review Luo Shunchang, Li Sitao, Cai Yao, Shi Congcong, Xiao Xin, Hao Hu Clinical Focus    2022, 37 (1): 57-61.   DOI: 10.3969/j.issn.1004-583X.2022.01.011 Abstract （1099）   HTML （0）    PDF（pc） （1071KB）（218）       Knowledge map    Save Objective To investigate the clinical and genetic characteristics of child sufferer with Coffin-siris syndrome(CSS). Methods The clinical features, laboratory tests and genetic tests of a case of CSS diagnosed in the Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University from February 2018 to February 2019 were collected. The “CSS”, “ARID1B” and “CSS” were selected as key words, the papers collected by China National Knowledge Infrastructure, Knowledge Service Platform of Wanfang Data and PubMed from January 2010 to November 2019 were retrieved. Clinical features and genetic characteristics of children with CSS were summarized. Results The child sufferer with CSS demonstrated unique facial features, specific skeleton & limb deformities, developmental retardation and cognitive delay, mental retardation, hearing and speech disorder, etc. The mutations of ARID1B genes were almost new mutations, and pathogenic variants were almost cut off. The heterozygous mutation of ARID1B gene c.2248C>T (p.R750*) was detected in the child sufferer, and it was an nonsense mutation. The parents did not carry such mutation, indicating that the mutation was a new mutation. Conclusion CSS is mainly caused by the mutation of ARID1B gene, it is almost new mutation, and no significant genotype-phenotype correlation is found. The heterozygous mutation of ARID1B gene c.2248C>T (p.R750*) in this case is classified to be autologous new mutation, no related gene is reported in China, and the gene mutation spectrum of CSS in China is supported to be enriched. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Effects of autologous hematopoietic stem cell transplantation in primary central nervous system lymphoma Cheng Li, Huang Wenrong Clinical Focus    2021, 36 (10): 901-904.   DOI: 10.3969/j.issn.1004-583X.2021.10.007 Abstract （1036）   HTML （0）    PDF（pc） （384KB）（115）       Knowledge map    Save The effects of autologous hematopoietic stem cell transplantation(ASCT) in the whole treatment process remain to be unknown to abundant physicians due to low incidence of primary central nervous system lymphoma(PCNSL). Induction therapy based on high-dose methotrexate(HD-MTX) has significantly improved the early control rate of PCNSL, and many patients receive insufficiently thorough remission. Large-scale international clinical studies show that the rate of complete remission(CR) is less than 50% in most case; while the duration of remission remain short and recur within one year. ASCT, a consolidation therapeutic strategy, is applied to primary or relapsed and refractory PCNSL, significantly improved the rate of complete remission and long-term disease-free survival(PFS); the long-term PFS of newly treated PCNSL patients can hit 70%, and that of relapsed and refractory PCNSL patients can hit 50%. Current clinical practices confirmed that PCNSL is more common in older patients. Elderly PCNSL patients with great organ functions remained to tolerate ASCT, significant benefited from ASCT. High-dose thiotepa is preferred for ASCT conditioning regimen of PCNSL, and TBC regimen with stronger conditioning intensity is patients for young patients with better physical conditioning failing reciveing CR after early induction therapy; Older patients are supported to choose TT-BCNU or reduced TBC conditioning regimen. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Methylmalonic acidemia: clinical phenotype and genetic characteristics Zhao Wanqing, Zhang Yanan, Wei Chenxi, Bai Xinli Clinical Focus    2022, 37 (2): 145-149.   DOI: 10.3969/j.issn.1004-583X.2022.02.010 Abstract （951）   HTML （0）    PDF（pc） （397KB）（166）       Knowledge map    Save Objective To explore the clinical characteristics, laboratory examination and genotype of mut-type methylmalonic acidemia (MMA) to provide basis for the diagnosis and treatment of mut-type MMA.Methods A retrospective analysis of clinical manifestation, general examination, serum and urine metabolism, gene detection results of 18 children with mut-type MMA admitted to the pediatric endocrinology, genetics and metabolism clinic of the Second Hospital of Hebei Medical University from December 2015 to June 2020 was performed.Results Mut-type MMA were common in less than 1 year infant, in those patients, main clinical manifestations presented vomiting, drowsiness, even convulsions, dyspnea and disturbance of consciousness in severe. Gene mutation of 18 children was caused by methylmalonyl-CoA mutase (MUT), detecting totally 20 mutations; the mutation sites were mainly c.729_730insTT, and with diversification of mutation types.Conclusion Mut-type MMA, a atypical clinical manifestations, should be reference urine metabolism, genetic testing is considered to be a reliable evidence for clinical classification with diversification of mutation types. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical data and genotype of cblC type methylmalonic acidemia: 19 cases report analysis Wei Chenxi, Zhao Wanqing, Zhang Yanan Clinical Focus    2022, 37 (1): 46-51.   DOI: 10.3969/j.issn.1004-583X.2022.01.009 Abstract （918）   HTML （0）    PDF（pc） （909KB）（105）       Knowledge map    Save Objective To provide thinking and measures for early diagnosis by exploring the relations between clinical characteristics, laboratory examination and genotypes of cblC type methylmalonic acidemia.Methods The data of clinical manifestation, gene results, tandem mass spectrometry, imageological examination of 19 children with methylmalonic acidemia admitted to the Department of Pediatric Endocrinology and Growth Development, the Second Hospital of Hebei Medical University from 2016 to 2020 were retrospectively analyzed. Results There were 10 male and 9 female patients in out of 19 cases, of which 8 cases were confirmed by neonatal screening. A total of 13 mutations were found by genetic testing, the most common mutations satisfied c.609G>A, followed by the mutations satisfying c.80A>G and c.656_ c.658delAGA. Initial neurological symptoms of 11 cases who were not confirmed by neonatal screening were feeding difficulties, developmental delay, poor response, visual impairment, convulsions, etc. C3 /C0, C3 /C2, urinary methylmalonic acid and homocysteine were significantly elevated in tandem mass spectrometry. Laboratory testing data showed that multiple organs were damaged involving the blood system, nervous and digestive systems, etc. Conclusion The clinical manifestations and laboratory examination of children with cblC type methylmalonic acidemia demonstrate diversely with poor specificity. The genotypes showing the termination or frame-shift mutation normally develop early and have relatively severe symptoms may be show severe neurological complications including the hydrocephalus. The late-onset conditions are mild and have better prognosis by early treatment. late-onset disease of children is easily ignored normally, causing delayed diagnosis on pathogenetic condition. It is necessary to take early diagnosis on cblC type methylmalonic acidemia Attributing to great improvements of the condition and prognosis. Neonatal tandem mass spectrometry screening makes for the early diagnosis, and genotype detection contribute to specific disease classification and targeted treatment, thereby reducing the disability rate and mortality of the disease. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical diagnosis and treatment in 1 case of exfoliative dermatitis caused by Pembrolizumab as well as cutaneous toxicity analysis of 44 cases treated with Pembrolizumab contemporaneously Huang Jiayuan, Pan Banzhou, Ji Hong, Mei Jingfeng, Fan Zhaohui, Zhou Yun Clinical Focus    2022, 37 (2): 150-154.   DOI: 10.3969/j.issn.1004-583X.2022.02.011 Abstract （862）   HTML （0）    PDF（pc） （837KB）（81）       Knowledge map    Save Objective Clinically, increasing immune-related adverse events cause concern with the promotion and application of immunotherapy. The tolerability profile could be effectively improved by controlling immune-related skin adverse reactions to enhance efficacy.Methods In this article regarding the diagnosis and treatment of severe immune-related adverse skin toxicity in a recent patient was reported. Meanwhile, a skin toxicity analysis were performed on 44 patients who received pembrolizumab in our hospital with a review of the related literature.Results Among 44 patients received pembrolizumab, only a few patients presented itchy skin and rash. The symptomatic treatment effect of hormone was good not affecting the continued use pembrolizumab. One case with severe exfoliative dermatitis withdrew immunotherapy although which resolved by active treatment.Conclusion Although the incidence of immune-related skin adverse reactions is low, it is essential to provide reasonable intervention theoretical basis and practical strategy regarding the diagnosis and treatment of immune-related adverse reactions. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical characteristic of Primary biliary cholangitis complicating Sjögren syndrome Wang Dandan, Zhang Xiaolan, Deng Zhihua Clinical Focus    2022, 37 (1): 30-34.   DOI: 10.3969/j.issn.1004-583X.2022.01.005 Abstract （802）   HTML （0）    PDF（pc） （974KB）（79）       Knowledge map    Save Objective To investigate the clinical characteristics of primary biliary cholangitis (PBC) complicating Sjögren syndrome (SS). Methods The medical records of patients diagnosed with PBC and primary Sjögren syndrome (pSS) from November 2010 to June 2016 at Second Hospital of Shanxi Medical University were collected to analyze the clinical characteristics of the patients. Results A higher proportion of females and a longer course of disease were found in PBC complicating SS group versus PBC-only group; liver injury-related symptoms and biochemical indicators in the baseline data were milder in PBC complicating SS group in comparison with PBC-only group during diagnosis confirmed; patients diagnosed with PBC at the initial diagnosis and combined with SS at a later stage had more dry mouth symptoms than those of PBC-only patients at the initial diagnosis; anti-SSB antibody positivity rate and fever symptoms were more common in patients with pSS than those with PBC combined. There was no difference in the progression of cirrhosis and hepatic decompensation between PBC complicating SS patients and PBC-only patients at year 1 and 5. Conclusion Although PBC complicating SS in patients have characteristics of both PBC and pSS, those are not identical, and the combination of the two diseases does not accelerate disease progression. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Risk factors of intraoperative acquired pressure injury: A systematic review and meta-analysis Song Siping, Jiang Qixia, Liu Xiaoqing Clinical Focus    2022, 37 (3): 211-219.   DOI: 10.3969/j.issn.1004-583X.2022.03.003 Abstract （793）   HTML （0）    PDF（pc） （2243KB）（156）       Knowledge map    Save Objective To systematically identify the risk factors of intraoperative acquired pressure injury(IAPI) to provide a basis for the prevention IAPI. Methods A systematic search regarding to IAPI risk factors in PubMed, Web of Science, Cochrane library, OVID, EMBASE, Chinese Biomedical Database(CBM), China National Knowledge Infrastructure(CNKI), Wanfang Data from January 2000 to July 2019 was performed to collect from January 2000 to July 2019. According to the criterias for inclusion and exclusion, screening eligible literature and data, evaluating the quality of included studies were all conducted by independent two reviewers, and using RevMan5.3 and Stata15 for a Meta-analysis. Results Totally 22 studies were recruited, including 267, 152 cases. In the Mate-analysis, 13 risk factors were involved, among which age, gender, body mass index(BMI)<23 kg/m2, operation duration, low preoperative Braden score, lateral position, supine position were the main risk factors for IAPI. Conclusion The older age, BMI <23 kg/m2, lower preoperative Braden score, longer operative duration are related to higher risk for IAPI female patients. Presently, because of insufficient evidence on risk factors of IAPI among patients and sample size of each study varied greatly, the effects of gender, comorbidities, operation position, intraoperative special medication, cardiopulmonary bypass, intraoperative hypotensive episodes are still inconclusive, and more high-quality studies are needed to supplement and improve for future research. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Effect of high frequency and low frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke spasticity: A comparative study Xia Jing, Chen Miaocun, Lin Min, Hao Youguo Clinical Focus    2022, 37 (5): 427-430.   DOI: 10.3969/j.issn.1004-583X.2022.05.007 Abstract （731）   HTML （0）    PDF（pc） （859KB）（127）       Knowledge map    Save Objective To compare the clinical effect between high frequency and low frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke spasticity. Methods Totally 54 post-stroke spasticity patients were randomely divided into the high frequency group (n=18), the low frequency group (n=18) and the control group (n=18). In addition of 4-week routine treatment (secondary prevention medications+rehabilitation training), the high frequency group were additionally treated with high-frequency rTMS on the affected side, the low frequency group additionally with low-frequency rTMS on the healthy side. The control group did not receive rTMS. The effect assessment was conducted before and after treatment. The therapeutic effect was determined by comparing the motor evoked potentials (MEP) latency of wrist flexor muscles on the affected side, central motor conduction time (CMCT), Fugl-Meyer assessment (FMA) of upper extremity (FMA-UE), Modified Ashworth Scale (MAS), clinical spasticity index (CSI), Modified Barthel Index (MBI).Results The difference was not statistically significant in the related indicators among the three groups before treatment (P>0.05). After treatment, FMA-UE, MBI score in groups were significantly increased, while wrist flexor MAS, CSI, MEP latency, CMCT were apparently decreased (P<0.05). Among the three groups, FMA, MBI were remarkably increased in the frequency groups than in the cortrol group, and wrist flexor MAS, CSI, MEP latency, CMCT were obviously decreased when compared with the cortrol group (P<0.05), the high frequency group was more prevalent (P<0.05). Conclusion For post-stroke spasticity patients, both the high frequency rTMS on the affected side and the low-frequency rTMS on the healthy side can relieve post-stroke spasticity and elevate the FMA-UE score, which is safe and effective. And the high frequency rTMS on the affected side is better than low frequency rTMS on the healthy side. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical characteristics and drug resistance of community-acquired Acinetobacter baumannii pneumonia Zhu Ying, Shu Qianqian, Chen Fuhui Clinical Focus    2022, 37 (4): 315-319.   DOI: 10.3969/j.issn.1004-583X.2022.04.005 Abstract （721）   HTML （0）    PDF（pc） （903KB）（110）       Knowledge map    Save Objective To investigate the clinical features and drug resistance of pathogens in community-acquired pneumonia patients with Acinetobacter baumannii, and to strengthen clinicians' understanding for the pneumonia. Methods From January 2020 to June 2021, a total of 44 pneumonia patients with community-acquired Acinetobacter baumannii pneumonia from the Department of Respiratory Medicine, the Second Affiliated Hospital of Harbin Medical University were enrolled, bacterial identification and drug sensitive test were performed. The clinical data and outcomes were retrospectively analyzed. Results Community-acquired Acinetobacter baumannii pneumonia patients were often accompanied by cardio-cerebral disease and/or chronic lung disease, and their clinical manifestations mainly included cough, expectoration, dyspnea, and fever. In pulmonary CT, polymorphic changes, and bilateral lung involvement were more common. Acinetobacter baumannii exhibited varying degree of drug resistance, the resistance rate of beta-lactamases (carbapenems, piperacillin/tazobactam) and quinolones (ciprofloxacin) was higher, and the rate of carbapenems resistance was as high as 54.5%. Conclusion Patients with community-acquired pneumonia cased by Acinetobacter baumannii are mainly the aged who are usually suffering from cardio-cerebral disease and pulmonary disease in such situation. Furthermore, most of those patients are critically ill, but with a low mortality rate. Drug resistance of the pathogens discovered from those patients varies in different degree. All these characteristics needs to be concerned. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Levels and clinical significance of RDW, NT-proBNP, BigET-1, HMGB1 in patients with idiopathic pulmonary arterial hypertension An Qinyan, Jiang Rong, Kang Bin, Du Ming, Zhou Renming, Zhao Hongjuan, Duan Yi, Lu Fei, Liu Jinming Clinical Focus    2021, 36 (11): 1001-1004.   DOI: 10.3969/j.issn.1004-583X.2021.11.008 Abstract （710）   HTML （0）    PDF（pc） （849KB）（105）       Knowledge map    Save Objective To explore the changes and clinical significance of red blood cell distribution width(RDW), N-terminal pro-brain natriuretic peptide(NT-proBNP), big endothelin-1(BigET-1), high mobility group protein-B1(HMGB1) in patients with idiopathic pulmonary arterial hypertension(IPAH).Methods Totally 80 IPAH patients admitted to our hospital from Nov 2019 to Oct 2020 were enrolled as the observation group,the control group comprised 80 healthy volunteers undergoing physical examination in our hospital during the same period; the aim was to compare RDW, NT-proBNP, BigET-1, HMGB1 as well as echocardiogram indexes between groups; and the correlation of the above indicators was analyzed. Results Compared with control group, RDW, NT-proBNP, BigET-1, HMGB1 in observation group were significantly higher (all P<0.01), left ventricular end diastolic dimension(LVEDD) was notably smaller (P<0.01), right ventricular end diastolic diameter(RVEDD) was significantly larger (P<0.01). Correlation analysis showed that RDW, NT-proBNP, BigET-1, HMGB1 were negatively correlated with LVEDD, left ventricle ejection fraction(LVEF), cardiac index(CI), while positively correlated with RVEDD. Positive correlation existed between NT-proBNP, HMGB1 and pulmonary artery mean pressure(PAMP), pulmonary vascular resistance(PVR)(P<0.05).Conclusion RDW, Nt-proBNP, BigET-1, HMGB1 in IPAH patients are increased, and the indexes are related to LVEDD, PAMP, PVR, and those can be used as references for diagnosis and evaluation of IPAH. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Correlation of serum sST2 and liver function, platelet level and Ishak score in chronic hepatitis B patients Wang Yuanyuan, Cheng Ning, Lin Haiyan Clinical Focus    2021, 36 (11): 976-980.   DOI: 10.3969/j.issn.1004-583X.2021.11.003 Abstract （710）   HTML （0）    PDF（pc） （953KB）（62）       Knowledge map    Save Objective To observe the expression of serum soluble suppression of tumorigenicity-2 (sST2) in patients with chronic hepatitis B (CHB), and to analyze the correlation of sST2 and liver function, platelet(PLT) and Ishak score. Methods Totally 190 inpatients with CHB who met the inclusion criteria were prospectively enrolled from December 2018 to December 2020 in Dalian Sixth People's Hospital. The patients were divided into no fibrosis (29 cases), fibrosis (124 cases), and cirrhosis (37 cases) according to Ishak inflammation score. Thirty healthy controls in the physical examination center during the same period were recruited. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin (ALB), total bilirubin (TBIL), sST2 and PLT were detected, and APRI was counted. Results There were significant differences in serum sST2, AST, ALT, ALB, TBIL, APRI and PLT among four groups (P<0.05). Compared with controls, sST2, AST, ALT and TBIL in CHD patients were significantly higher (P<0.05), while serum ALB was significantly lower (P<0.05). Compared with patients with and without fibrosis, serum sST2, AST, ALT and TBIL of cirrhosis patients were significantly higher (P<0.05), while ALB and PLT were significantly lower (P<0.05). Compared with controls, PLT of cirrhosis patients was significantly lower (P<0.05). Pearson results showed that sST2 of CHB patients was closely related to AST, ALT, ALB, TBIL, PLT and APRI (r=0.939, 0.918, -0.816, 0.795, -0.469, 0.933, P<0.05). Spearman results showed that there was positive correlation between serum sST2 and Ishak score (r=0.885, P<0.05). Multivariate analysis showed that AST, ALT, ALB, TBIL, PLT, and Ishak score were influencing factors for sST2. The AUC values of the area under ROC curve of SST2, APRI and the combined diagnosis of cirrhosis were 0.715, 0.789 and 0.806. The sensitivity were 0.700, 0.780 and 0.810. The specificity 0.903, 0.847, 0.855, respectively. Conclusion For CHB patients, when serum sST2 abnormally elevates, liver fibrosis increases. At the same time, influencing factors for serum sST2 are liver function indexes. PLT and Ishak score, and serum sST2 combined with APRI can improve the predictive value of cirrhosis. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Analysis on risk factors of postoperative hemorrhage of endoscopic submucosal dissection in early gastric cancer Lu Xunda, Feng Zhijie, Ji Chenguang, Yin Kaige, Liu Li Clinical Focus    2021, 36 (12): 1087-1091.   DOI: 10.3969/j.issn.1004-583X.2021.12.006 Abstract （707）   HTML （0）    PDF（pc） （392KB）（76）       Knowledge map    Save Objective To systematically analyze the risk factors of postoperative hemorrhage of endoscopic submucosal dissection (ESD) in early gastric cancer (EGC). Methods A total of 281 EGC patients who underwent ESD treated in the second Hospital of Hebei Medical University from January 2017 to February 2021 were analyzed retrospectively. These patients were divided into control group and postoperative bleeding group on the basis of occurrence of postoperative hemorrhage. The previous history, inpatient medical records, pathologic diagnosis, report on endoscopy were collected, and the key observation was sex, age, whether or no preoperative antiplatelet therapy, whether with hypertension, diabetes, ischemic angiopathy; tumor location, endoscopic classification, histological classification, tumor diameter, operation time; whether complicated by ulcer, vascular tumor thrombus; whether block resection or complete resection; whether or no postoperative bleeding, as well as the postoperative bleeding time, ect. The risk factors for postoperative hemorrhage of ESD in EGC patients were analyzed by univariate and multivariate Logstic regression. Results There were 16 cases with postoperative bleeding (5.69%, 16/281) in out of 281 EGC patients, with bleeding time was from day 1 to day 9 postoperation; of which 8 cases (50.0%, 8/16) had postoperative bleeding within 24 hours, 10 cases (62.5%, 10/16) had postoperative bleeding within 48 hours, 1 patient had two consecutive bleeding within 48 hours, and 1 patient developed hemorrhagic shock, those patients successed in hemostasis under endoscope.The independent risk factor for postoperative hemorrhage of ESD in EGC patients was preoperative antiplatelet therapy (OR=0.051, 95% CI 0.011-0.230, P<0.01), operation time ≥2 hours (OR=0.048, 95% CI 0.009-0.263, P<0.01) and complication by ulcer (OR=0.038, 95% CI 0.007-0.193, P<0.01). Conclusion Independent risk factor for postoperative hemorrhage of ESD in EGC patients was operation time more than 2 hours, preoperative antiplatelet therapy, complication by ulcer. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Searching for an optimal therapy for H.pylori eradication: High-dose proton-pump inhibitor dual therapy vs. bismuth-containing quadruple therapy Huang Yehong, Liu Gaifang, Xin Chenxi, Zhao Yunhong, Wu Jing Clinical Focus    2022, 37 (3): 230-233.   DOI: 10.3969/j.issn.1004-583X.2022.03.006 Abstract （696）   HTML （0）    PDF（pc） （870KB）（132）       Knowledge map    Save Objective To compare the eradication rate and adverse incidence of proton pump inhibitor high dose dual therapy with bismuth-containing quadruple therapy for Helicobacter pylori (H.pylori). Methods From January 2021 to August 2021, a total of 208 patients with positive H.pylori admitted to the Department of Gastroenterology, Hebei General Hospital were enrolled and randomly grouped into experimental group (n=105, proton pump inhibitor high dose dual therapy) and control group (n=103, bismuth-containing quadruple therapy). The patients in experimental group were given oral administration of esomeprazole 40 mg two times a day and amoxicillin 750 mg a day, and patients in control group were given esomeprazole 20 mg two times a day, colloidal bismuth subcitrate 220 mg two times a day, amoxicillin 1 000 mg two times a day, Furazolidone 100 mg two times a day. The treatment period for both groups was 14 days; after 4 week, 13C/14C urease breath test (13C/14C-UBT) for detecting H.pylori infection was performed and the eradication rate and adverse incidence were compared.Results The eradication rate of H.pylori for the experimental group and the control group were 77.1% and 82.5% (P=0.334) in intention-to-treat (ITT) analysis; the eradication rate of H.pylori for the experimental group and the control group were 82.7% and 87.6%(P=0.329) in per-protocol (PP) analysis. The incidence of adverse reactions in the experimental group was 9.0%, which was significantly lower than 19.0% in the control group (P=0.042). Adverse reactions in the experimental group were mainly bloating, diarrhea and rash; adverse reactions were mainly oral odor, constipation and abdominal pain in the control group. Conclusion The eradication rate was similar both proton pump inhibitor high dose dual therapy and bismuth-containing quadruple therapy; but proton pump inhibitor high dose dual therapy has significantly lower incidence for adverse reactions, expecting to be optimal eradication program. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Manifestation and correlation of deceleration capacity and heart rate deceleration runs and heart rate variability of myocardial ischemia in patient Yu Dan Clinical Focus    2021, 36 (12): 1083-1086.   DOI: 10.3969/j.issn.1004-583X.2021.12.005 Abstract （668）   HTML （0）    PDF（pc） （367KB）（28）       Knowledge map    Save Objective To investigate the manifestation and correlation of heart rate deceleration capacity(DC), heart rate deceleration runs(DRs) and heart rate variability(HRV) in patients with myocardial ischemia(MI), in order to provide reference for MI. Methods From october 2019 to August 2020, totally 86 patients with chronic MI were enrolled, of which 59 inpatients with asymptomatic myocardial ischemia(SMI) were regarded as treatment group A, 27 patients with angina pectoris(AP) as treatment group B, 60 healthy adults suspected MI admitted to our hospital were comprised control group, 24h dynamic electrocardiogram(DCG) were monitored, the correlation of DC, Drs and HRV were compared in groups. Results DC, DRs (DR4, DR8) were lower in two treatment groups than in control group (all P<0.05); standard deviation(SD) of all normal to normal(NN) intervals(SDNN), standard deviation of the 5-min average of N-N intervals(SDANN), square root of the mean squared difference of successive RR intervals(RMSSD), percetange of adjacent NN intervals differing by more than 50 milliseconds (pNN50) were lower in two treatment groups than in control group (all P<0.05) ; The above indexes were slightly lower in treatment group A than in treatment group B, but the differences were not statistically significant (all P>0.05). A significant positive correlation were found between DC, DR2, DR4, DR8 and SDNN, SDANN, RMSSD, pNN50 in MI patients (all P<0.05). Conclusion The levels of DC, DRs, HRV in MI patients are lower in comparison with healthy people; and DC, DRs are significantly positively correlated with HRV. DC, DRs, HRV can provide reference for clinical examination of MI. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Study on standardized diagnosis and treatment of primary immune thrombocytopenia Fu Haixia Clinical Focus    2021, 36 (10): 896-900.   DOI: 10.3969/j.issn.1004-583X.2021.10.006 Abstract （667）   HTML （0）    PDF（pc） （443KB）（219）       Knowledge map    Save Primary immune thrombocytopenia(ITP) is an acquired immune-mediated thrombocytopenia disease, and its pathogenesis covers excessive destruction of platelets and insufficient production of platelets by megakaryocytes. Main clinical manifestations involve the bleeding related to thrombocytopenia and fatigue. No specific biomarker is found in the diagnosis of ITP, and other thrombocytopenic diseases should be excluded. The therapy is intended to maintain the safe level of platelets, prevent bleeding and improve the quality-of-life. The indication for therapy is platelet count ≤ 30×10 9/L and/or active bleeding. Patients with some factors may increase the risk of bleeding: increased age, heavy physical activities, blood coagulation factor disorder, uncontrolled hypertension, and taking anticoagulants. These patients need to maintain platelet at a higher level. The first-line therapies involve corticosteroids and intravenous human immunoglobulin. The second-line therapies involve thrombopoietin receptor agonists(TPO-RAs), recombinant TPO(rhTPO), rituximab and splenectomy. All-trans retinoic acid(ATRA) and other third-line treatment should be considered for refractory ITP. Reference | Related Articles | Metrics | Comments（0）

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Diagnostic value of galactomannan on the comorbidity of bronchiectasis and pulmonary aspergillosis Zhou Jingkun, Yang Caihong, Feng Tao, Cui Huaying Clinical Focus    2022, 37 (9): 799-803.   DOI: 10.3969/j.issn.1004-583X.2022.09.006 Abstract （654）   HTML （0）    PDF（pc） （447KB）（34）       Knowledge map    Save Objective To compare the efficacy of galactomannan (GM) in serum and bronchoalveolar lavage fluid (BALF) in the diagnose of the comorbidity of bronchiectasis and pulmonary aspergillosis (PA). Methods Totally 128 bronchiectasis patient from the Department of Respiratory and Critical Care Medicine, Shengli Oilfield Central Hospital (March 2018- March 2021) were enrolled into observation group (n=41, including 12 diagnosed cases and 29 clinically diagnosed cases) and control group (n=82) as the diagnostic result. The serum GM and BALF-GM were respectively conducted to detect in two groups before instituting anti-Aspergillus therapy, the receiver operating characteristic (ROC) curves were drawn to compare the diagnostic value of the two detection on the comorbidity of bronchiectasis with PA and assess the cut-off values of serum GM and BALF-GM. Results The Optimal cut-off values of were 0.65 μg/L for serum GM (area under the ROC curve [AUROC] of 0.856; sensitivity of 65.4%; specificity of 88.5%) and 0.93 μg/L for BALF-GM (AUROC of 0.929; sensitivity of 80.4%; specificity of 95.0%). At a cut-off value of 1.5μg/L, the specificity and sensitivity in serum-GM were 11.5% and 100%, respectively; but at a cut-off value of 2.0 μg/L, those in BALF-GM were 19.2% and 100%, respectively. Conclusion BALF-GM is superior to serum GM for the sensitivity and specificity in the diagnose of the the comorbidity of bronchiectasis and PA, preferring to assist the diagnosis as a tool. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Comparative analysis on pathological results of preoperative & postoperative colorectal intraepithelial neoplasia and early colorectal cancer endoscopic therapies Shi Yujuan, Wang Jing, Xu Ping Clinical Focus    2023, 38 (1): 55-59.   DOI: 10.3969/j.issn.1004-583X.2023.01.007 Abstract （639）   HTML （0）    PDF（pc） （850KB）（119）       Knowledge map    Save Objective To provide reference for the improved pathological diagnosis of lesions of the tissues by exploring pathological differences of preoperative and postoperative endoscopic polypectomy for colorectal intraepithelial neoplasia and early colorectal cancer. Methods One hundred and twenty nine patients receiving both biopsies and surgeries based on the inclusion and exclusion criteria were selected as study samples, the specimen data and preoperative pathology biopsy data of 129 patients diagnosed with high-grade colorectal intraepithelial neoplasia or early colorectal cancer patients under endoscopic mucosal resection (EMR)/ endoscopic submucosal dissection (ESD) were retrospectively analyzed, differences in preoperative and postoperative pathological results were compared, and the risk factors associated with pathological differences in preoperative and postoperative endoscopic therapies were analyzed. Differences in the accuracy of pathological biopsies and EMR/ESD samples of patients with different parts (ascending colon, transverse colon, descending colon, sigmoid colon, rectum), lesion morphology (pedicled, sessile and lateral developmental morphology), maximum diameter of lesions, gender and age were observed. Results The diagnostic accordance rate of the postoperative pathological diagnosis of preoperative colonoscopy biopsies and endoscopic EMR/ESD therapies was 17.1% (22/129), the number of postoperative pathological ascending and descending lesions of endoscopic therapies amounted to 103 cases (79.8%) and 4 cases (3.1%), respectively, the mild-severity judgment rate of sites was 82.4%, 80.0%, 85.7%, 80.9% and 76.7%, respectively, and differences weren’t statistically significant (P>0.05). The results of single-factor Logistic regression analysis showed that the phenomenon of mild-severity judgments on preoperative biopsies was more obvious in patients with pedunculated polyps, and difference was statistically significant (P<0.05), while difference in mild-severity judgment rate for preoperative biopsies was not statistically significant for the lesion site, maximum diameter, sex, and age (P>0.05). Conclusion Both the preoperative pathological biopsy diagnosis and postoperative EMR/ESD pathological diagnosis with low compliance rate provide certain basis for selection on endoscopic follow-up and surgical treatment. Patients with pedunculated polyps are vulnerable to mild severity judgment for preoperative biopsies. Therefore, patients with pedunculated polyps are subject to intraepithelial neoplasia diagnose via biopsies, EMR/ESD surgery is supported to be selected based on the conditions in combination with narrow band imaging and magnifying endoscopy technique, and necessities for follow-up treatment and endoscopic follow-up time are supported to be determined by combining the pathological diagnosis on postoperative specimens. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Predictive value of ApoB/ApoA1 ratio on the extent of coronary artery disease in patients with unstable angina pectoris Zhu Jun, Liu Yue, Chen Shuxia, Wang Xian, Zheng Luyan, Gu Jian Clinical Focus    2022, 37 (5): 422-426.   DOI: 10.3969/j.issn.1004-583X.2022.05.006 Abstract （637）   HTML （0）    PDF（pc） （1096KB）（92）       Knowledge map    Save Objective To explore the predictive value of ApoB/ApoA1 ratio on the degree of coronary artery lesions in patients with unstable angina (UA). Methods One hundred and seventy six patients with UA who were hospitalized and underwent coronary angiography in the Department of Cardiovascular Medicine, Hebei General Hospital from October 2019 to August 2021 were retrospectively analyzed. Clinical data of the enrolled patients were collected, ApoB/ApoA1 ratio was calculated, and Gensini score was calculated based on coronary angiography results. The median Gensini score of UA patients was used to divide the patients into the high Gensini score group (Gensini score ≥40) and low Gensini score group (Gensini score <40), and clinical data of patients in two groups were compared. Correlation analysis on Gensini scores and ApoB/ApoA1 ratio in UA patients was performed. Binary multivariate Logistic regression was applied to analyze the independent risk factors for high Gensini score. ROC curves were applied to analyze the diagnostic value of ApoB/ApoA1 ratio and other lipid indices for high Gensini score, and the best diagnostic threshold was determined by the Yordon index. Results The ApoB/ApoA1 ratio of patients in the high Gensini score group was significantly higher than that of patients in the low Gensini score group (P<0.01). The Gensini score of UA patients was positively correlated with the ApoB/ApoA1 ratio (r=0.321, P<0.01). Binary multivariate Logistic regression analysis showed that ApoB/ApoA1 ratio was an independent risk factor for severe coronary lesions (Gensini score ≥40) in UA patients (OR=4.593, 95%CI=2.434-8.664, P<0.01). ROC curve analysis showed that the diagnostic value of ApoB/ApoA1 ratio was higher than that of ApoB, TG, TC and LDL-C, with an AUC of 0.723(P<0.01), an optimal diagnostic threshold of 0.69, a sensitivity of 0.644 and a specificity of 0.742.Conclusion The ApoB/ApoA1 ratio is positively correlated with the degree of coronary artery lesion in UA patients, and it has a certain diagnostic and predictive value and serves an independent risk factor for severe coronary artery lesions in UA patients, delivering guiding significance in the clinical diagnosis and treatment of UA. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Efficacy comparison between pull and surgical technique for removal of peritoneal dialysis catheter Cheng Huidong, Si Bolin, Hua Qin, He Jianqiang, Gui Lanlan Clinical Focus    2021, 36 (12): 1097-1101.   DOI: 10.3969/j.issn.1004-583X.2021.12.008 Abstract （631）   HTML （0）    PDF（pc） （586KB）（59）       Knowledge map    Save Objective To compare the effecacy of pull and surgical technique for removal of peritoneal dialysis (PD) catheter. Methods We retrospectively analyzed 88 patients undergone PD catheter removal admitted to Affiliated Hospital of Jiangsu University during the past decade (2011-2020). intra-operative and post-operative were performed on the two groups which comprised 39 (pull technique) and 49 (surgical technique) patients. The tension test of the catheter in pull technique group was conducted to explore resistance of PD catheter. Results In comparative trials, operating duration, pain score and proportion of patients with blood loss than 10 ml of pull technique patients were less than those of surgical technique patients (P<0.05); Similar infection rate was found between groups; decreased fracture (pull) in PD catheter was in opposite to its life extension. Conclusion Pull technique for PD catheter is convenient and safe then worthy of promotion. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Correlation analysis between neutrophil percentage-to-albumin ratio and degree of coronary artery stenosis Chen Xi, Jiang Shan Clinical Focus    2022, 37 (1): 26-29.   DOI: 10.3969/j.issn.1004-583X.2022.01.004 Abstract （622）   HTML （0）    PDF（pc） （996KB）（108）       Knowledge map    Save Objective To explore the relationship between neutrophil percentage-to-albumin ratio (NPAR) and the degree of coronary artery stenosis. Methods A total of 406 patients who underwent coronary angiography (CAG) in Jinzhou Central Hospital from November 2020 to July 2021 were selected. They were divided into the non-CHD group (84 cases) and the CHD group (322 cases) as the CAG result. Gensini score was used to evaluate the degree of coronary artery stenosis. The independent risk factors for coronary heart disease and the correlation between Gensini score and NPAR were evaluate by Multivariate Logistic regression analysis and Spearman correlation analysis, respectively. Receiver operating characteristic (ROC) curve was drawed to assess the predictive value of NPAR for coronary heart disease. Results The independent risk factors for coronary heart disease are age, gender, high-sensitivity C-reactive protein, NPAR. Gensini score was positively correlated with NPAR (r=0.364, P<0.01); the areas under curve of the ROC curve was 0.687(95%CI 0.632-0.741, P<0.05), and the cutoff value, sensitivity, specificity of NPAR were 1.6128,50.3%, and 85.7%, respectively. Conclusion NPAR is positively correlated with the coronary artery stenosis degree, which has certain predictive value for coronary heart disease. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Correlation between cardiac troponin and D-dimer levels and mortality in COVID-19 critical illness patients: A meta analysis Guo Ru, Liu Ruihong, Lin Xuefeng, Han Xuanmao, Zhang Zhu, Chen Ruiying Clinical Focus    2022, 37 (4): 293-298.   DOI: 10.3969/j.issn.1004-583X.2022.04.001 Abstract （620）   HTML （0）    PDF（pc） （1583KB）（125）       Knowledge map    Save Objective To evaluate the correlation between cardiac troponin (cTn) and D-dimer (D-D) levels and mortality in coronavirus disease 2019 (COVID-19) critical illness patients. Methods We searched related researches using COVID-19 and cTn as keyword in PubMed, Wanfang Journal Database, CNKI, VIP Chinese Scientific and Technological Periodical Database (VIP), etc., the period is from January 1, 2020 to December 31, 2021. Two reviewers independently conducted this work. We performed Meta-analysis using RevMan5.3 software, and the results were expressed as relative risk (RR) and its 95% confidence interval (CI). Results There were eligible15 literatures in the analysis, the Newcastle-Ottawa Quality Assessment Scale(NOS) scores were ≥6, and involving 7290 inpatients with COVID-19 critical illness, of which 1820 as the death group and 5470 as the survival group. Meta-analysis results showed that both elevated cTn level (RR=3.13, 95%CI=2.13-4.62, Z=5.76, P<0.01) and up-regulated D-D level (RR=1.69, 95%CI=1.27-2.26, Z=3.60, P=0.0003) of COVID-19 patients had obviously higher mortality. The results of gender subgroup analysis indicated that the mortality of COVID-19 male patients was more prevalent (P<0.01). Conclusion For COVID-19 critical illness patients, both elevated cTn level and up-regulation D-D level are more likely to rise mortality. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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The standard treatment of acute lymphoblastic leukemia Lu Wenyi, Zhao Mingfeng Clinical Focus    2021, 36 (10): 874-879.   DOI: 10.3969/j.issn.1004-583X.2021.10.002 Abstract （604）   HTML （0）    PDF（pc） （484KB）（182）       Knowledge map    Save Acute lymphoblastic leukemia(ALL) is a highly heterogeneous hematological malignancy resulting from clonal proliferation of lymphoid precursor cells. In recent years, with the optimization of risk stratification model and the emergence of new drugs, such as tyrosine kinase inhibitors, monoclonal antibodies, chimeric antigen receptor T cells and other targeted drugs, the outcomes of ALL patients have been greatly improved. This article briefly described the current standards for treatment of ALL. Also, the latest progress in the therapy of ALL were discussed. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Influencing factors and predictive indicators of vascular calcification Zheng Lihua, Du Runsen, Zhao Yaheng, Liu Peng Clinical Focus    2022, 37 (2): 114-118.   DOI: 10.3969/j.issn.1004-583X.2022.02.003 Abstract （602）   HTML （0）    PDF（pc） （472KB）（107）       Knowledge map    Save Objective To analyze the predictive factors of vascular calcification, and to explore its effective prediction indicators.Methods A retrospective analysis was performed in totally 467 vascular calcification patients admitted to the Department of Vascular Surgery, the First Hospital of Hebei Medical University from August 2018 to July 2020. Those patients were registered into case group and control group as whether with or without vascular calcification, and the clinical data were collected. Univariate and multivariate Logistic regression analysis were used to explore influencing factors of vascular calcification. Receiver operating characteristic (ROC) curve was drawn to analyze predictive value.Results In 467 cases, there were 191 cases (40.9%, 191/467) with vascular calcification. The independent factors for predicting vascular calcification were albumin/fibrinogen ratio(OR=0.725, 95%CI 0.630-0.834, P<0.01), fibrinogen degradation product (OR=1.626, 95%CI 1.086-2.433, P=0.018), lipoprotein (OR=1.003, 95%CI 1.002-1.004, P<0.01), high density lipoprotein-cholesterol (OR=0.101, 95%CI 0.016-0.630, P=0.014), total cholesterol (OR=4.009, 95%CI 1.619-9.926, P<0.01), low density lipoprotein-cholesterol (OR=0.148, 95%CI 0.042-0.517, P<0.01), and the area under the curve (AUC) related the above parameters were 0.828, 0.780, 0.720, 0.679, 0.570, and 0.563, respectively.Conclusion The independent predictors for vascular calcification were albumin/fibrinogen ratio, fibrinogen degradation product, lipoprotein, high density lipoprotein-cholesterol, total cholesterol, low density lipoprotein-cholesterol, of which, albumin/fibrinogen ratio, fibrinogen degradation product and lipoprotein is better capable of predicting vascular calcification, and albumin/fibrinogen ratio has top advantageous value. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Diagnosis value of serum lipoprotein α, cystatin-C and uric acid on early diabetic nephropathy Gao Shixin, Song Bing, Shi Kexin Clinical Focus    2022, 37 (3): 248-252.   DOI: 10.3969/j.issn.1004-583X.2022.03.009 Abstract （598）   HTML （0）    PDF（pc） （956KB）（72）       Knowledge map    Save Objective To analyze the diagnostic value of serum lipoprotein (α)[LP(α)], cystatin-C (Cys-C) and uric acid (UA) on early diabetic nephropathy (DN). Methods In this retrospective analysis, 150 diagnosed type 2 diabetes mellitus (T2DM) patients admitted to Huludao Central Hospital from January 2020 to August 2021 were enrolled, according to urinary albumin/creatinine ratio (UACR), those patients were assigned into normal albuminuria (NA) group (n=50, UACR: 0~3 mg/mmol), microalbuminuria (MA) group (n=51, UACR: 3~29 mg/mmol), clinical albuminuria (CA) group (n=49, UACR>30 mg/mmol). The general clinical data, correlated clinical indexes, Serum LP(α), Cys-C, UA level were detected and compared among three groups. Pearson's correlation and Logistic regression analysis were used to analyze the correlation between each index and DN; receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of each index for DN.Results Among three groups, difference was statistically significant in the systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P<0.05); there were significant differences in the serum creatine (SCr), estimated glomerular filtration rate (eGFR), fasting plasma glucose (FPG), glycosylated hemoglobin A1c (HbA1c), Cys-C, UA, LP(α) (P<0.05). LP(α) in MA group significantly increased when compared with NA group, with statistically significant difference (P<0.05). Pearson's correlation showed that serum Cys-C, UA, LP(α) were positively correlated with UACR and SCr, while negatively correlated with eGFR. Logistic regression analysis showed that the independent risk factors for early DN included Cys-C and LP(α). The results of ROC curve analysis showed that serum Cys-C and LP(α) had high diagnostic value for early DN. Conclusion Different degrees of renal damage in T2DM patients were reflected by Serum LP(α), Cys-C and UA, of which LP(α) and Cys-C being independent risk factors for early DN. The highest accuracy emerges in the combined of the three, with high diagnostic efficacy of prediction for early DN. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Hereditary spherocytosis caused by SPTB gene hybrid mutation: a case report Wen Xue, Zhang Zhihua, Zhang Rongjuan, Hao Changlai Clinical Focus    2021, 36 (11): 1019-1023.   DOI: 10.3969/j.issn.1004-583X.2021.11.012 Abstract （596）   HTML （0）    PDF（pc） （1343KB）（104）       Knowledge map    Save Retrospective analsis concerned with the clinical data of a patient with hereditary spherocytosis (HS), and SWISS-MODEL software used for protein structure prediction of SPTB gene mutation. The literatures were reviewed. Blood routine of the patient in clinic showed anemia, RBC, WBC and platelet decreased. Gene sequencing analysis proved that heterozygous mutation of SPTB gene c.5551C>T (exon26, NM_001355436) underwent spontaneous mutation. Protein structure prediction was c.5551C>T (p.Q1851X) mutation caused protein truncation mutation, and merged with heterozygous mutation of ANK1 gene c.1495G>T (p.A499S). The mutation site was agnate source, and non-pathogenic gene was confirmed. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinical Focus    2022, 37 (1): 72-76.   DOI: 10.3969/j.issn.1004-583X.2022.01.014 Abstract （594）   HTML （3）    PDF（pc） （909KB）（116）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Analysis of the incidence and risk factors for venous thromboembolism in 145 patients with diffuse large B-cell lymphoma Shen Rui, Lei Yanhua, Jia Haokun Clinical Focus    2022, 37 (1): 43-45.   DOI: 10.3969/j.issn.1004-583X.2022.01.008 Abstract （594）   HTML （0）    PDF（pc） （866KB）（91）       Knowledge map    Save Objective To explore the incidence and risk factors for venous thromboembolism (VTE) in 145 patients with diffuse large B-cell lymphoma (DLBCL). Methods Totally 145 DLBCL patients admitted to our hospital from May 2016 to August 2019 were selected and divided into a VTE group (n=22) and a non-VTE group (n=123) as the results in ultrasonography for VTE. Multivariate Logistic regression was used to analyze the risk factors for VTE in DLBCL patients, as well as the difference of recurrence rate, recurrence-free survival rate, and overall survival rate between groups. Results The independent risk factors for VTE were intravenous catheterization, non-complete remission (non-CR) after 3-4 courses of chemotherapy, D-dimer level ≥1.44 μg/ml(OR=5.143, 9.000, 16.514, P<0.05). But performance status (PS) score ≥2 was considered a protective factor (OR=0.170, P<0.05); there was no significant difference in recurrence rate, recurrence-free survival rate, and overall survival rate between groups (P>0.05). Conclusion Independent risk factors for VTE in DLBCL patients were Intravenous catheterization, non-CR after 3-4 courses of chemotherapy, D-dimer ≥1.44 μg/ml, and protective factor for VTE is PS score ≥2. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Predictive value of dual-energy CT for Ki-67 expression in gastric stromal tumors and relationship with pathological factors Yuan Shichao, Zhao Qing, Fan Hongyan Clinical Focus    2021, 36 (11): 1013-1018.   DOI: 10.3969/j.issn.1004-583X.2021.11.011 Abstract （586）   HTML （0）    PDF（pc） （980KB）（32）       Knowledge map    Save Objective To explore the predictive value of dual-energy CT for Ki-67 expression in gastric stromal tumors(GST) and its relationship with pathological factors. Methods Totally 82 GST patients admitted from February 2019 and April 2020 were retrospectively selected. Dual-energy CT were performed to measure Ki-67, the patients were divided into two groups based on Ki-67 expression, namely 39 cases in high expression group (Ki-67>6%), 43 cases in low expression group (Ki-67≤6%). Pathological factors were analyzed in between groups, and CT parameters were compared between Ki-67 different expressions. Receiver operating characteristic(ROC) curve analysis were used to analyze the predictive value of CT parameters, the correlation between Ki-67 index expression and pathological factors by Pearson's correlation coefficient. Results The values of each phase (40 keV, 50 keV, 60 keV, 70 keV) and iodine concentration(IC), normalized iodine concentration(NIC) on arterial and venous phase were higher in high expression group than in concurrent low expression group (P<0.05). The area under curve(AUC) of the parameters to identify Ki-67 expression on venous phase were 0.867, 0.907, 0.939, 0.758, 0.952 and 0.854, respectively, and with 0.998, 0.944, 0.967, 0.888, 0.925 and 0.764 on arterial phase, respectively. Pearson's correlation analysis showed Ki-67 expression were negatively correlated with the parameters. Meanwhile the indexes negatively correlated with single/multiple, nuclear division, with or without bleeding, tumor location. A positively correlated was found between Ki-67 expression and the risk classification.Conclusion Dual-energy CT value of each phase (40 keV, 50 keV, 60 keV, 70 keV), and IC value, NIC value on arterial and venous phase are negatively correlated with Ki-67 expression, which may reflect GST cell proliferation, moreover Ki-67 expression can use to be an important reference index for prognosis and risk grading of GST. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Diagnostic value of ultrasound with serology and BRAF testing in the identification of benign and malignant TI-RADS category 4 nodules Hu Yuhan, Chen Fei Clinical Focus    2022, 37 (4): 339-342.   DOI: 10.3969/j.issn.1004-583X.2022.04.010 Abstract （580）   HTML （0）    PDF（pc） （1050KB）（56）       Knowledge map    Save Objective To explore the diagnostic value of ultrasound with serology and BRAF testing in the identification of benign and malignant thyroid imaging reporting and data system (TI-RADS) category 4 nodules.Methods The data of 102 patients with TI-RADS category 4 nodules form department of ultrasound, the First Affiliated Hospital of Jinzhou Medical University were retrospectively analyzed, and serological and BRAF gene tests were performed in all of them. Patients were divided into benign group and malignant group according to surgical and pathologic findings, the different diagnostic efficacy in differentiating benign and malignant TI-RADS category 4 nodules was evaluated.Results TI-RADS indicated the numbers of hypoechoic rim with internal calcification, blurred boundary, irregular shape of patients with malignant nodules was more than those of patients with benign nodules (P<0.05). The higher thyroid-stimulating hormone (TSH) value of patients with malignant nodules was common (P<0.05). The numbers of BRAF gene mutation of patients with malignant nodules were significantly higher than those of patients with benign nodules (P<0.05). The accuracy (98.04%), sensitivity (97.22%), specificity (100.00%) and diagnostic efficiency (0.926) of ultrasonography, serology and BRAF testing were higher than any of the three alone check (P<0.05).Conclusion The combined of the above three has more clinical value in the identification of benign and malignant TI-RADS category 4 nodules. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Relations between aspirin & clopidogrel resistance-relatedgene polymorphisms and corresponding recurrent cerebral infarction Liu Debin, Chen Xiaopu, Chen Wenjie, Huang Yinting, He Wenzhen Clinical Focus    2022, 37 (4): 320-324.   DOI: 10.3969/j.issn.1004-583X.2022.04.006 Abstract （579）   HTML （0）    PDF（pc） （904KB）（141）       Knowledge map    Save Objective To observe aspirin & clopidogrel resistance-related gene polymorphisms, and to explore their relations with recurrent cerebral infarction. Methods A total of 98 cerebral infarction patients were selected from the Department of Neurology in our hospital from April 2019 to December 2020, and the relations between aspirin & clopidogrel resistance-related gene polymorphisms and gender & recurrent cerebral infarction were retrospectively analyzed. Results In patients suffering from cerebral infarction, patients severely resistant to aspirin were more likely to have recurrent cerebral infarction on standard anti-platelet therapy than sensitive patients (P<0.05); the patients suffering from the moderate/severe resistance to aspirin with medium/slow metabolism of clopidogrel complicated were more likely to have recurrent cerebral infarction than aspirin sensitivity and (or) fast metabolism of clopidogrel (P<0.05). The difference in the proportion of different clopidogrel drug-related gene phenotypes wasn’t statistically significant (P>0.05); and the difference in the distribution of aspirin & clopidogrel resistance-related phenotypes with different genders wasn’t statistically significant (P>0.05). Conclusion It is crucial to test aspirin & clopidogrel resistance-related phenotypes in the treatment of cerebral infarction, and it is necessary to appropriately adjust the therapeutic regimen according to test results to improve the therapeutic effects on cerebral infarction. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Relationship between tuberculin test with serum apolipoprotein A-1 and anti-tuberculosis drug-induced liver injury Qu Ying, Liu Zhongyang Clinical Focus    2022, 37 (1): 39-42.   DOI: 10.3969/j.issn.1004-583X.2022.01.007 Abstract （572）   HTML （0）    PDF（pc） （942KB）（62）       Knowledge map    Save Objective To explore the relationship between tuberculin test (PPD) with serum apolipoprotein A-1 (ApoA-1) and anti-tuberculosis drug-induced liver injury (ATB-DILI). Methods Totally 541 tuberculosis patients diagnosed at 967 Hospital of the Joint Logistics Support Force of PLA from January 2017 to June 2021 were divided into case group (56 cases) and control group (485 cases) as whether or not ATB-DILI, and the general clinical data of included subjects were recorded. Influencing factors of ATB-DILI were analyzed by binary Logistic regression, and receiver operating characteristic (ROC) curve was used to determine the predictive value of PPD test and serum ApoA-1 for ATB-DILI.Results The patients in case group were more positive PPD test, decreased ApoA-1 level as compared to the patients in control group, and with statistically significant difference between groups (all P<0.05). The ROC curve showed that strong positive PPD test and ApoA-1 level <1.175 g/L could play a part of independent factors for judging ATB-DILI. Conclusion Response intensity of PPD test and ApoA-1 level has certain predictive value for ATB-DILI, and the combination of the two displays a more higher predictive value for ATB-DILI. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Effects of dual coping intervention on coping ability and marital adjustment of young adult patients with breast cancer and their spouses Gu Jiahua, Wu Qi Clinical Focus    2022, 37 (9): 822-826.   DOI: 10.3969/j.issn.1004-583X.2022.09.011 Abstract （567）   HTML （1）    PDF（pc） （855KB）（136）       Knowledge map    Save Objective To explore the effect of dual coping intervention on coping ability and marital adjustment of young adult patients with breast cancer and their spouses. Methods The young ault postoperative patients with breast cancer and their spouses (n=80 pairs), who visited the Department of Breast, the International Peace Maternity & Child Health Hospital of China welfare institute (June 2021 to September 2021) were randomized to recevie conventional care (control group, n=40 pairs) or dual coping intervention + conventional care (observation group, n=40 pairs) for 4 months, aiming to compare intergroup coping ability and marital adjustment.Results Before intervention, the two groups had insignificant differences in the total scores and dimension scores of the dyadic coping inventory (DCI) scale and Locke-Wollance marital adjustment scale (LWMAS) (all P>0.05); after intervention, the observation group had significantly higher total scores and dimension scores of DCI scale and LWMAS than the control group (all P<0.05).Conclusion Dual coping intervention can improve the coping ability and marital adjustment of young adult patients with breast cancer and their spouses, which contributes to the improvements in marital quality and happiness. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Clinicopathological analysis of colorectal mixed adeno-neuroendocrine carcinoma: 8 cases report Zhang Yiming, Li Mingzhao, Gu Xin Clinical Focus    2022, 37 (10): 921-926.   DOI: 10.3969/j.issn.1004-583X.2022.10.007 Abstract （557）   HTML （0）    PDF（pc） （2523KB）（63）       Knowledge map    Save Objective To explore the clinicopathological features of colorectal mixed adeno-neuroendocrine carcinoma (MANEC). Methods A retrospective analysis were porformed in 8 patients underwent MANEC eradication in Tianjin Hospital of ITCWM (Nankai Hospital) from August 2016 to December 2020. Results There were 3 female and 5 male, age averaged 63 years among these patients. Their clinical manifestations obviously had no-specificity, with the imaging showing space occupying and lymph node metastasis.The tumor marker detection verified 2 cases of significantly elevated ferritin, 2 cases of significantly elevated carcinoembryonic antigen (CEA), and all cases of insignificantly elevated alpha-fetoprotein and carbohydrate antigen 199 (CA199). The preoperative biopsy were conducted in 6 cases, 5 cases of adenocarcinoma and 1 case of adenocarcinoma or MANEC, with main space occupying in colon. There were 5 cases for ulcer type, 3 cases for protuberant type, with the maximum diameter of tumor for 3-9 cm. Under light microscope, the tumor cells of adenocarcinoma were arranged like glandular tubes, and 2 cases were accompanied with mucinous adenocarcinoma; neuroendocrine tumor cells showed diffuse, nest like or organ like distribution, including 1 case of small cell type and 7 cases of large cell type. Lymph node metastasis was found in 7 cases and liver metastasis in 1 case. Immunohistochemistry indicated that cytokeratin8/18 (CK8/18), cytokeratin19 (CK19) and CEA were positive to varying degrees in adenocarcinoma, chromogranin A (CgA), synaptophysin (Syn) and cluster of differentiation 56 (CD56) were positive to varying degrees in neuroendocrine tumors, and 40%-80% of Ki-67 hot spots were positive. Five patients survived, the median survival time was 17 months, and two patients died, the average survival time was 8 months. Conclusion Colorectal MANEC is a highly malignant tumor characterized by lower morbidity, no-specificity, and incident lymph node metastasis, its diagnosis mainly depends on pathology with immunohistochemistry. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

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Standardized treatment of acute myeloid leukemia Liu Qiaoxue, Wei Hui Clinical Focus    2021, 36 (10): 880-883.   DOI: 10.3969/j.issn.1004-583X.2021.10.003 Abstract （554）   HTML （0）    PDF（pc） （366KB）（81）       Knowledge map    Save Acute myelogenous leukemia(AML), a malignant blood system disease characterized by clonal proliferation and differentiation of primitive hematopoietic cells, is classified to be a heterogeneous disease, and the treatment of AML should be comprehensively considered in combination with chromosomal and molecular abnormalities, prognosis risk classification and chemotherapy tolerance of patients. Common solutions for remission induction involve DA, HA and HAD solutions, and the selection on consolidation and maintenance therapeutic regimen after remission should be considered in combination with prognosis risks of patients. Up to now, for standardized treatment of AML, Hematopoietic stem cell transplantation is still one of the most important means. The treatment of gerontal patients with AML faces more severer challenges, and targeted therapy for specific sites of leukemia cells has become the most promising therapeutic regimen, and its combination with conventional induction chemotherapy will become emerging strategy and idea for treatment of gerontal patients with AML. Reference | Related Articles | Metrics | Comments（0）

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Correlation between blood lipid and homocysteine and cognitive impairment in Parkinson's disease Guo Chang, Shen Huinan, Sun Yimeng, Wang Dongyu Clinical Focus    2022, 37 (2): 128-132.   DOI: 10.3969/j.issn.1004-583X.2022.02.006 Abstract （548）   HTML （0）    PDF（pc） （387KB）（58）       Knowledge map    Save Objective To investigate the correlation between the levels of blood lipid and homocysteine (Hcy) and the degree of cognitive impairment in Parkinson's disease (PD).Methods A total of 100 PD patients and 50 healthy people admitted to the Department of Neurology of Jinzhou Central Hospital during Sept 2019 - Aug 2021 were respectively registered into PD group and control group. According to the score of Montreal cognitive Assessment(MoCA), patients in PD group were divided into 38 patients with normal cognition (PD-NC), 32 patients with mild cognitive impairment (PD-MCI) and 30 patients with PD dementia (PDD). The aim was to detect levels of blood lipid and serum Hcy of all patients, explore the differences of indicators between groups, and analyze the correlation between the above indicators and the degree of cognitive impairment.Results Compared with control group, PD group had significantly higher level of Hcy (P<0.05), lower levels of total cholesterol (TC), triglyceride (TG) and low density lipoprotein cholesterol(LDL-C) (P<0.05), significant differences existed in the levels of TG, LDL-C and Hcy among PD-NC subgroup, PD-MCI subgroup and PDD subgroup (P < 0.05). Logistic regression analysis showed that Hcy was an independent risk factor for PD cognitive impairment (P<0.05).Conclusion There is a certain correlation between the levels of TG, LDL-C and Hcy and the degree of cognitive impairment for PD patients. Table and Figures | Reference | Related Articles | Metrics | Comments（0）