Table of Content

05 February 2016, Volume 31 Issue 2

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Advances in clinical researches on cerebrovascular diseases in 2015

Zhang Yusheng, Chen Yunyu, Chen Danxia, Dong Dawei, Mai Hongcheng, Xu Anding

2016, 31(2):  117-122.  doi:10.3969/j.issn.1004-583X.2016.02.001

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Many substantial advances have been made in the clinical researches on cerebrovascular diseases in 2015. The article reviews the following new advancements in endovascular treatment of acute ischemic stroke, stenting for symptomatic intracranial artery stenosis, new thrombolytic agents, neuroprotectants, folic acid therapy in primary prevention of stroke, treatment for cervical artery dissection, guidelines on cerebrovascular diseases, and development of the construction of stroke in China.

The Year in cardiology 2015

Cui Wei

2016, 31(2):  123-130.  doi:10.3969/j.issn.1004-583X.2016.02.002

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A lot of advances in cardiology occurred in the year 2015, especially in the respects of hypertension, heart failure, coronary artery disease, lipid lowering, cardiac arrhythmias, and deep vein thrombosis/pulmonary embolism. This review focuses on the blood pressure control, treatment of chronic heart failure and coronary artery disease, new drugs in lipid lowering, treatment strategies for cardiac arrhythmias and pulmonary embolism.

Clinical advances of digestive diseases during 2015

Zhang Xiaolan, Guo Jinbo, Yin Fengrong

2016, 31(2):  131-142.  doi:10.3969/j.issn.1004-583X.2016.02.003

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Gastroenterology related guidelines and consensus have been well revised, updated or newly made during 2015, covering the maximum variety and updates of the digestive diseases. Clinical consensuses formulated by professors in China provide great convenience to disease diagnosis and treatment, as suiting the national condition. This review will focus on Helicobacter pylori associated gastritis, functional dyspepsia of the elder, gastroendoscope, gastrointestinal hemorrhage,inflammatory bowel disease,hepatic disease and pancreatic disease. The aim is to give a support in the diagnosis and treatment of digestive diseases for gastroenterologists by summarizing the advances of above diseases.

Clinical advances in pulmonary during 2015

Yuan Yadong, Chen Ye,Wang Li,Shen Lixiao

2016, 31(2):  143-150.  doi:10.3969/j.issn.1004-583X.2016.02.004

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In 2015, with the development of the clinical and basic research on respiratory system disease, various guides are also inconstant update. Now, we will do simple introduction about the related development in lung infection, pulmonary vascular disease, interstitial lung disease, lung cancer, chronic bronchial disease and so on.

Research advances of myeloid neoplasmas in 2015

Ren Jinhai, Guo Xiaonan, Guo Xiaoling, Cai Shengxin

2016, 31(2):  151-155.  doi:10.3969/j.issn.1004-583X.2016.02.005

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The research advances of myeloid neoplasms in 2015 will be introduced,such as new molecularly targeted therapies for acute myeloid leukemia(AML),reclassifying myelodysplastic syndromes(MDS),precise diagnosis and risk assessment of MDS,novel therapeutic approaches of MDS,refining risk stratification and treatment strategy in primary myelofibrosis.

Major clinical progress of rheumatic disease in 2015

Gao Lixia, Guo Huifang

2016, 31(2):  156-161.  doi:10.3969/j.issn.1004-583X.2016.02.006

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The clinical progress of rheumatic disease mainly concentrated in the change of management guidelines and treatment strategies in rheumatoid arthritis, rheumatic polymyalgia, IgG4 related disease and psoriasis arthritis during 2015. At the same time, the diagnostic criteria of primary Sjogren syndrome and gout were updated. The guidelines of systemic lupus erythematous (SLE) -associated pulmonary arterial hypertension were made, and our domestic rheumatologists made management suggestions for SLE patients during pregnancy and the puerperium. Both rheumatism itself and comorbidity attracted attention to in 2015, especially rheumatic diseases complicated with cardiovascular disease, and patient educations were more emphasized.

Clinical advances in endocrine and metabolic disease in 2015

Wang Mian, Zhang Lihui, Su Shenou

2016, 31(2):  162-167.  doi:10.3969/j.issn.1004-583X.2016.02.007

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In 2015, development in the field of endocrine metabolism is rapid and colorful.Not only a lot of important guidelines have updated or issued, but also highlights in clinical research harvests much, covering the obesity, diabetes mellitus, thyroid disease, parathyroid disease, adrenal gland and gonad diseases, and others.The authors review and summarize the major progresses.

Major progress in kidney disease in 2015

Xu Jinsheng, He Lei, Zhang Shenglei

2016, 31(2):  168-174.  doi:10.3969/j.issn.1004-583X.2016.02.008

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In the past 2015, several aspects in kidney disease have increased dramatically, including the risk factors in kidney disease, diagnosis and treatment in primary and secondary kidney disease. The review describes the particularly progress in the biomarker of predictor and outcome of kidney disease, the diagnosis and treatment of primary kidney disease, secondary kidney disease and related complications.

The key treatment principle of acute ischemic stroke still to improve collateral and micro circulation right the first time for non-thrombolysis patients

Li Zhenzhong

2016, 31(2):  175-177.  doi:10.3969/j.issn.1004-583X.2016.02.009

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Despite the existence of numerous therapeutic targets for acute ischemic stroke in theory, improving the blood supply to the brain comes first in clinical practice. Thrombolysis constitutes the only approved therapy for acute ischemic stroke. However,　only 1.6% of the patients with acute ischemic stroke received thrombolytic therapy within the time window in China.　And the question raises: what else could we do for non-thrombolysis patients after acute cerebral infarction right the first time?　In clinical practice, we found that the key to treat the patients with ischemic cerebrovascular disease is still to improve and recover cerebral perfusion, and the cerebral collateral circulation plays an important role right the first time.

Research progress of ultra earlier thrombolysis for acute ischemic stroke

Sun Xue,Yang Guoping

2016, 31(2):  178-181.  doi:10.3969/j.issn.1004-583X.2016.02.010

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Stroke is an acute cerebrovascular disease with high rate of incidence,mutilation andmortality.Fast and effective treatment after the onset of stroke can decrease the recurrence rate and mortality. In recent years, grasping the treatment time window to treat acute ischemic stroke is becoming a hotspot.The main method for acute ischemic stroke is ultra earlier thrombolysis including intra-arterial thrombolysis,intravenous thrombolysis and a combination of both. This article will review the research progress of all kinds of ultra earlier thrombolysis treatment in recent years to find a suitable method for clinical application.

Dl-3-n-butylphthalide effect in treatement of acute cerebral infarction

Sun Yuanyuan,Li Hui,Lang Wenjuan,Feng Jiachun

2016, 31(2):  182-186.  doi:10.3969/j.issn.1004-583X.2016.02.011

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The mechanism of ischemia and reperfusion injury in acute cerebral infarction is extremely complex. Dl-3-n-butylphthalide, as a new neuroprotective agent which has been widely used in clinic, could play the role of antagonizing cerebral ischemia via blocking multiple links in ischemia and reperfusion injury. In this paper, we review the specific mechanism of dl-3-n-butylphthalide.

Clinical efficacy and language recovery of butylphthalide injection in aphasia patients with cerebral infarction

Wu Xiaona, Liu Yan, Xiang Wei, Xiong Tiegen, Li Chunyong,Deng Wenting

2016, 31(2):  187-190.  doi:10.3969/j.issn.1004-583X.2016.02.012

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Objective To study the clinical efficacy of butylphthalide injection and the language recovery in aphasia patients with cerebral infarction.Methods Twenty-six aphasia patients with acute cerebral infarction were randomly divided into two groups, treatment and control. Both groups were treated with anti-platelet and basic therapy conventionally, but the treatment group was treated with butylphthalide injection, 100 ml, intravenously, 1/12 h for (11± 3) d. NIHSS and AQ were recorded before and after treatment.Results Before treatment,the gender, age, onset time, NIHSS score and complications of the patients,such as hypertension, diabetes, hyperlipidemia in two groups had no significant difference (P>0.05). After treatment, the scores of NIHSS decreased in two groups (P＜0.01). However, the score of treatment group decreased significantly compared with that of control group (P＜0.05). The clinical efficacy and the improvement of AQ were significantly better than those of control group (P<0.05).Conclusion Butylphthalide injection in the treatment of aphasia patients with cerebral infarction can improve the clinical function effectively and promote the recovery of language function injury at the same time, it also has a high security in clinical application.

Effect of salvianolate on serum levels of hs-CRP and TNF-α in unstable angina patients

Mao Yanyang,Wang Junqiang,Wang Chenxia,Wang Congxia

2016, 31(2):  191-193.  doi:10.3969/j.issn.1004-583X.2016.02.013

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Objective To observe the effect of salvianolate on plasma high-sensitivity C-reactive protein(hs-CRP) and tumor necrosis factor( TNF-α) in unstable angina(UA) patients.Methods Ninety-six UA patients were divided into two groups. Control group of 48 cases received conventional western medicine treatment,48 cases in the treatment group received salvianolate on the basis of control group treatment. Two weeks was as a period of treatment. The therapeutic effect was evaluated after two courses. The level of hs-CRP and TNF-α in two groups were detected before and 1 week,2 weeks after treatment.Results Before treatment,hs-CRP and TNF-α levels between two groups had no statistically significant (P>0.05). After treatment for 1 week and 2 weeks hs-CRP in observation group was (12.5±2.2) mg/L and (5.2±1.1) mg/L respectively, while that in the control group was (15.3±2.8) mg/L and (8.5±1.5) mg/L. There was the significant difference between two group (P<0.05); Moreover, TNF-α in observation group was significantly lower than that in control group (P<0.05). The efficacy in observation group was 93.8% (45/48), that in control group was 77.1% (37/48).The observation group was significantly higher than the control group (P<0.05).Conclusion Salvianolate combined treatment might improve the clinical symptoms of UA patients by decreasing hs-CRP and TNF-α.

Relationship between serum homocysteine,hs-CRP and acute coronary syndrome in young and middle age patients

Du Huiqi, Qin Qin, Li Yang

2016, 31(2):  194-197.  doi:10.3969/j.issn.1004-583X.2016.02.014

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Objective To investigate the correlation of serum homocysteine,high sensitive C reactive protein(hs-CRP) and acute coronary syndrome(ACS) in young and middle aged patients.Methods A total of 142 in young and middle age ACS patients who received coronary angiography and hospitalized in Tianjin Chest Hospital were included. The patients were divided into two groups, acute myocardial infarction(AMI) group (n=61),and unstable angina (UAP) group (n=81). A normal control group was selected (n=60). Serum homocysteine,hs-CRP were tested for all subjects. The correlation of serum homocysteine,hs-CRP and ACS were analyzed.Results Serum homocysteine and hs-CRP in AMI group were significantly different from those of normal control and UAP group (P<0.05).There were no significant differences between UA group and normal control group. Serum homocysteine and hs-CRP were both significantly correlated with Gensini score (r=0.17,0.26,P<0.05). Logistic analysis indicated the relationship between homocysteine and ACS.Conclusion Serum homocysteine and hs-CRP correlates significantly with ACS in young and middle age patients.They can provide reference value for the evaluation of coronary artery disease.

Predictive value of CHA₂DS₂-VASc score combining left atrial diameter for risk of stroke in patients with non-valvular atrial fibrillation

Geng Wei, Zhang Qi, Tian Xiang, Zhang Tongle, Liu Ying, Fu Yongqi, Qi Lei, Zhu Yao, Jin Lili

2016, 31(2):  198-200.  doi:10.3969/j.issn.1004-583X.2016.02.015

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Objective To explore the predictive value of CHA₂DS₂-VASc score combined with left atrial diameter for the risk of stroke in patients with non-valvular atrial fibrillation (NVAF).Methods A total of 230 patients with NVAF were selected. CHA₂DS₂-VASc score was calculated for each patient by the clinical history and auxiliary examination. All patients were followed up for one year after discharging from hospital, and the follow-up visit would be finished if patients suffered from stroke or followed up for one year. The patients were divided into stroke group and non-stroke group according to the follow-up results.Results The CHA₂DS₂-VASc score and left atrial diameter in the stroke group were higher than those of non-stroke group. The area under the ROC curve of CHA₂DS₂-VASc score, left atrial diameter and CHA₂DS₂-VASc score combined with left atrial diameter to predict the happening of stroke in patients with NVAF were respectively 0.789,0.753 and 0.835. There were significant difference in area under the ROC curve among CHA₂DS₂-VASc score, left atrial diameter and CHA₂DS₂-VASc score combined with left atrial diameter(P＜0.01).Conclusion The predictive value of CHA₂DS₂-VASc score combined with left atrial diameter is higher for the occurrence of stroke in patients with NVAF.

Clinical study of secondary prevention of aspirin in different ages of patients with cerebral infarction

Wu Xueyong, Lu Changsheng, Li Shanghua, Huang Xiong, Li Chunmei

2016, 31(2):  201-203.  doi:10.3969/j.issn.1004-583X.2016.02.016

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Objective To explore the secondary preventive effect of aspirin in different ages of patients with cerebral infarction.Methods A retrospective analysis was applied in all patients with cerebral infarction who were divided into five different age groups and every age group had the exposure group (aspirin treatment) and no-exposure group (control group). Recurrence of cerebral infarction, hemorrhage, subarachnoid hemorrhage and gastrointestinal bleeding were compared among groups.Results Incidence of recurrence of cerebral infarction in exposure groups were significantly lower than that of no-exposure groups (P＜0.05) and no-exposure groups had significantly lower incidence of gastrointestinal bleeding (P＜0.05) among different age groups. The increased incidence of cerebral and subarachnoid hemorrhage in exposure groups significantly decreased (P＜0.05) compared with no-exposure groups at 61-90 ages. In exposure groups at 41-80 ages, there were no significant difference in incidence of cerebral and subarachnoid hemorrhage (P＞0.05). However, the incidence of cerebral and subarachnoid hemorrhage raised significantly at 71-90 ages (P＜0.05). The number of patients who needed treat ment increased significantly at 71-90 ages (P＜0.05); The relative risk was highest at 61-70 ages and the attributive risk was highest at 81-90 ages.Conclusion There were differences in secondary prevention of aspirin in different ages of patients with cerebral infarction. There were maximum benefit and minimum risk to have secondary prevention of aspirin in patients with cerebral infarction at 41-60 ages.

A case report of stomach abscess and literature review

Zhang Yan, Zou Baicang, Lu Xiaolan, Zhang Li, Guo Yunlei

2016, 31(2):  204-206.  doi:10.3969/j.issn.1004-583X.2016.02.017

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Objective To analyze the stomach abscess and summarize its etiology, clinical manifestation, diagnosis and treatment.Methods The cases of stomach abscess were searched from Chinese Journals Full-text Database, VIP Chinese Science and Technology Periodical Database and Wanfang Digital Peridical database published before August 2015, a total of 22 patients were reported in domestic, the general situation, etiology, clinical manifestation, diagnostic methods, treatment and prognosis were analysed.Results The incidence was higher in male (13/22); main symptoms included abdominal pain, chills, fever and abdominal mass; common cause included infection, stomach injury because of foreign matter and stomach surgery; diagnostic methods included gastroscope and endoscopic ultrasonography, CT and exploratory laparotomy; treatments included anti-infection symptomatic treatment and surgical treatment; twenty patients were cured and two patients died.Conclusion Stomach abscess is rare and can be cured by early diagnosis and medical treatment to obviate the risk of serious complications and surgery.

Clinicopathologic characteristics of signet ring cell carcinoma in T1 gastric cancer

Chen Jian, Ren Gang, Cai Rong, Zhao Jianxi, Guo Chen, Li Huali

2016, 31(2):  207-210.  doi:10.3969/j.issn.1004-583X.2016.02.018

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Objective To analyze clinicopathologic characteristics of early signet ring cell carcinoma(SRC), and to differentiate the tumor with other histologic types in T1 gastric cancer.Methods A retrospective analysis was undertaken for 255 patients with early gastric cancer who had experienced curative gastrectomy or endoscopic biopsy. Among them, 27 patients had SRC.Results The patients with early SRC (50.7±2.2) y was much younger than the T1 gastric cancer of the poorly differentiated adenocarcinoma (57.3±1.42) y and tubular adenocarcinoma (60.6±1.0) y(P<0.01). Patients with early gastric SRC had a greater proportion of females than other histologic types(P<0.01). 63.0% of early gastric cancer (EGC) lesions in SRC located in the middle third of the stomach, and 77.8% macroscopic types of EGC in SRC were depressed. 77.8% of SRC lesions were limited within the mucosal layer,which were more than poorly differentiated adenocarcinoma(56.3%) and tubular adenocarcinoma(61.0%). Early SRC had a similar rate of lymph node metastasis(18.5%) to poorly differentiated adenocarcinoma(17.2%), and a higher rate than tubular adenocarcinoma(12.1%),but there were no statistically significant differences(P>0.05). There were no significant difference of tumor size among early SRC,poorly differentiated adenocarcinoma and tubular adenocarcinoma(P>0.05).In early SRC,there was no significance difference in lymph node metastasis according to depth of invasion(P>0.05).Conclusion In early gastric cancer, SRC is a distinct type of gastric carcinoma in terms of clinicopathologic characteristics,which may have some value in the treatment strategy and prognosis assessment.

Etiological analysis in 111 patients with ascites

Ma Xiaojuan, Zhang Xu, Jiang Yong

2016, 31(2):  211-213.  doi:10.3969/j.issn.1004-583X.2016.02.019

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Objective To explore the etiology of ascites,its gender and age distribution.Methods The clinical data of 111 patients with ascites of unknown cause were retrospectively analyzed.Results In 111 patients, 53 cases were males and 58 cases females with an average age of (54.7±13.2) years, including 44 cases with malignancy (39.6%), 40 cases with liver cirrhosis (36.0%), 18 cases with tuberculous peritonitis (16.2%), 6 cases with uncommon diseases and 3 cases with acatalepsy. In youth group (<40 years), there were 10 cases of tuberculous peritonitis, 2 cases of malignancy and 2 cases of liver cirrhosis. In middle-aged group (40-60 years), there were 19 cases of malignancy, 16 cases of liver cirrhosis and 5 cases of tuberculous peritonitis; In elderly group (≥60 years), there were 23 cases of malignancy, 22 cases of liver cirrhosis and 3 cases of tuberculous peritonitis.Conclusion The top three causes of ascites are malignancy, liver cirrhosis and tuberculous peritonitis. The most common cause in youth group is tuberculous peritonitis, the main causes in elderly group are malignant tumor and liver cirrhosis. Liver cirrhosis is more common in male patients. There is no gender difference in other causes of ascites.

Clinical feature of pleural effusion in 78 patients with rheumatoid arthritis

Chen Wenyu, Wang Juanjuan, Wang Zhiming

2016, 31(2):  214-217.  doi:10.3969/j.issn.1004-583X.2016.02.020

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Objective To investigate the feature of pleural effusion in patients with rheumatoid arthritis for the recognition of the disease.Methods The clinical feature of pleural effusion in patients with rheumatoid arthritis was retrospectively analyzed.Results There was no pleural effusion in patients with remission of rheumatoid arthritis, all patients with pleural effusion were in active phase of the disease, especially in moderate and high active phase, significant difference in the number of patients was detected in low, moderate and high active phases of rheumatoid arthritis between groups (P＜0.05). The average levels of erythrocyte sedimentation rate and C-reactive protein were significantly higher in pleural effusion group than in non-pleural effusion group. The positive rates of rheumatoid factor and anti-cyclic citrullinated peptide antibody were significantly higher in pleural effusion group than in non-pleural effusion group (P＜0.05). The average number of joint tenderness and swollen joint was significantly higher in pleural effusion group than in non-pleural effusion group and the average time of morning stiffness was significantly longer in pleural effusion group than in non-pleural effusion group (P＜0.05). Compared with non-pleural effusion group, the remission number of patients was significantly decreased in pleural effusion group (P＜0.05), and the number of new joint deformity was significantly increased in pleural effusion group (P＜0.05).Conclusion Rheumatoid arthritis patients present pleural effusion as an active signal of disease, which was positively correlated with immune index and clinical symptom and should get rigorously treated.

Distribution and antimicrobial resistance surveillance of Pseudomonas aeruginosa isolates

Wei Honglian, Yang Jing, Yuan Yin, Liu Yuehong, Shi Dongyan

2016, 31(2):  218-220.  doi:10.3969/j.issn.1004-583X.2016.02.021

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Objective To investigate the distribution and antimicrobial resistance of Pseudomonas aeruginosa isolated from clinical specimens and to make an effective control measure for carbapenem resistant P.aeruginosa.Methods Bacteria identification and drug sensitivity analysis were detected by VITEK 2 compact system (French bioMerieux), the result interpretation was according to the standard of CLSI 2014, and data were analyzed using WHONE5.6 software. Carbapenemases were determined using Carba NP test.Results There were 893 strains of P. aeruginosa isolated from all kinds of clinical samples in our hospital in 2014. Among them, mainly from the lower respiratory tract specimens (81.5%).The drug resistance of P. aeruginosa to Amikacin was the lowest (11.6%), followed by Piperacillin tazobactam and Levofloxacin, respectively 21.8% and 21.9%, the highest was Aztreonam (40.4%).Conclusion P. aeruginosa isolates were mainly form respiratory tract sputum specimens, Carbapenem resistant isolates were mainly from Department of respiratory medicine, ICU and Neurosurgery. Carbapenemases was mainly the Ambler class B metallo-β-lactamases (MBLs) of the VIM type. The use of antimicrobial agents should be reasonable in clinic and the monitoring of P. aeruginosa nosocomial infection should be strengthened.