Clinical Focus

Cognitive impairment and treatment strategies in patients with major depression and bipolar disorder

Wang Yongliang， Wang Xueyi

2017, 32(10): 829-833. doi:10.3969/j.issn.1004-583X.2017.10.001

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Cognitive impairment is a typical feature of mood disorders. Mood disorders include major depressive disorder (MDD) and bipolar disorder (BD). Cognitive impairment affects a patient's daily and social abilities. Therefore, in order to improve the quality of life, patients need to optimize their cognitive functions. In general, cognitive impairment develops as BD progresses, and cognitive impairment is more severe than depression. In this review， we discuss the differences of cognitive function in patients with MDD and BD. Four aspects were elaborated: ① comparison of cognitive function of MDD and BD patients； ② imaging identification of cognitive impairment； ③ factors affecting cognitive impairment； ④ therapeutic strategies for improving cognitive function.

Effect of hypercholesterolemia on cognitive function in patients with first onset depression

Li Ning， Yan Jinghui， Wang Chaomin， Zhou Shanshan

2017, 32(10): 834-836. doi:10.3969/j.issn.1004-583X.2017.10.002

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Objective To investigate the effect of hypercholesterolemia on cognitive function in patients with firstepisode middleaged depression， so as to provide a reliable theoretical basis for clinical treatment and prevention. Methods Middleaged depressive disorder patients who received treatment of the first onset of depression in the hospital were all righthanded. Depressive disorder patients with hypercholesterolemia were selected as study group(n=58)， and depression patients without hypercholesterolemia served as control group(n=60). The cogntion assessment tools (Wechsler Adult Intelligence Scale， Wechsler Memory Scale and WCST) were used to evaluate the cognitive function of two groups， and the cognitive function of two groups was compared.Results Digital span， fill in the blanks， recognition， and persistent error number of study group were significantly different as compared with those of control group(P<0.05).Conclusion Hypercholesterolemia aggravates the cognitive impairment in patients with depression.

Different doses of reteplase in treatment of acute cerebral infarction

Deng Ke， Wu Xiaoqiu， Zhang Yong

2017, 32(10): 841-844. doi:10.3969/j.issn.1004-583X.2017.10.004

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Objective To study the efficacy and safety of different dose reteplase therapy in patients with acute cerebral infarction. Methods The study was a casecontrol study. In accordance with the thrombolytic conditions prescribed by the Chinese guidelines for cerebrovascular prevention and treatment, patients with acute cerebral infarction within 6 hours of the onset time were treated with different doses of rPA (0.9 mg/kg or 0.6mg/kg) intravenous thrombolytic therapy. NIHSSbaseline， 24 hours after thrombolysis NIHSS， the mortality after three months and the incidence of symptomatic intracranial hemorrhage(sIcH) were compared. Results ① NIHSS score， time of onset， time of thrombolytic therapy and coagulation function after 12 hours were not statistically significant (P>0.05). ② NIHSS and 24 hours after thrombolysis NIHSS in different doses of thrombolysis were significantly reduced（P＜0.05). ③The incidence of sIcH in two different dosage groups， the mortality rate within 24 hours after thrombolysis and NIHSS and three months after thrombolysis were not statistically significant (P>0.05).Conclusion Different doses of rPA (0.9 mg/kg or 0.6 mg/kg) are both effective in thrombolytic therapy for acute cerebral infarction. Furthermore， there was no statistical difference between different doses in sIcH.

Electromyogram characteristics in patients with severe heat stroke

Qu Tinga， Zheng Weihonga， Lu Chengxiangb

2017, 32(10): 845-848. doi:10.3969/j.issn.1004-583X.2017.10.005

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Objective To investigate the clinical characteristics in patients with severe heat stroke. Methods Patients with severe heat stroke were grouped by combining whether or not rhabdomyolysis and peripheral nerve damage. Furthermore， the specific features of peripheral nerve damage were analyzed by electromyography. Results The proportion of nerve damage in patients with severe heat stroke was 40.9%. Patients combined with rhabdomyolysis had a higher proportion of nerve damage up to 71.4%(P<0.05). The electromyography of the median nerve， ulnar nerve， tibial nerve and common peroneal nerve in patients with nerve damage showed that both sensory nerve conduction velocity and motor nerve conduction velocity decreased significantly (P<0.05). Conclusion The patients with severe heat stroke had a high proportion of peripheral nerve injuries， and the sensory and motor nerve conduction velocity decreased significantly.

Correlation between brachialankle pulse wave velocity and risk factors for arteriosclerosis in middleaged and elderly patients

Sun Xiaodan

2017, 32(10): 849-853. doi:10.3969/j.issn.1004-583X.2017.10.006

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Objective To explore the relatioanship between brachialankle pulse wave velocity(baPWV) and risk factors for arteriosclerosis in middleaged and elderly patients. Methods The patients who admitted in the hospital from 2012 to 2016 were analyzed in baPWV. The inclusion criteria of 186 cases were recruited into this survey.According to the baPWV levels， the patients were divided into two groups： arteriosclerosis group(baPWV≥1 400 cm/s) and normal group(baPWV＜1 400 cm/s).The correlation between baPWV and risk factors for arteriosclerosis was analyzed by multivariate logistic regression analysis. Results The age， resting heart rate(RHR)， hypertension levels and baPWV of arteriosclerosis group were significantly higher than those of normal group(P＜0.05). The multivariate logistic regression analysis showed that hypertension levels and RHR were the independent risk factors of baPWV increase for middleaged and elderly patients except for age and smoking history(OR=3.220，95%CI=1.9125.422，P=0.000；OR=2.226，95%CI=0.8975.524，P=0.085；OR=2.175，95%CI=1.5832.990，P=0.000；OR=3.523，95%CI=1.6547.506，P=0.001).Serum total bilirubin was a protective factor(OR=0.378，95%CI=0.1520.937，P=0.036). Conclusion Age and smoking， hypertension levels， RHR were the independent risk factors of baPWV increase for middleaged and elderly patients， serum total bilirubin was a protective factor.

Change of γ-glutamyltransferase in different sex and lesions number with coronary heart disease

Feng Lei， Nian Shiyan

2017, 32(10): 854-857. doi:10.3969/j.issn.1004-583X.2017.10.007

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Objective To overall explore the diagnostic and estimated value of γglutamyltransferase(GGT) in different sex of coronary heart disease(CHD)， to study the correlation with other items. Methods The difference in GGT in same and different sex between test group and control group， the relationship between GGT and traditional factors were studied through the correlation analysis， the diagnostic value of GGT in CHD was evaluated by ROC curve. Results GGT showed significant difference between different sex in control group and in female between control and test group. There was no correlation with CHD but certain correlation with TG in male. On the other hand， there was positive correlation with CHD， correlation with age， HDLC， APOA， HCY in female. The area of ROC curve in diagnosis CHD by the value of GGT in female was 0.793. Conclusion The correlation of GGT with CHD has significant difference in different sex， there is no correlation with CHD in male， there is significant positive correlation with CHD in female. GGT has great value in diagnosis CHD in female， but there is no correlation with lesions number.

Characteristics and influencing factors of vascular calcification in maintenance hemodialysis patients

Zhou Fanli1， Lu Lan1， Fang Xian1， Long Kai1， Mao Yanqing2， Wu Chunxia1

2017, 32(10): 858-860. doi:10.3969/j.issn.1004-583X.2017.10.008

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Objective To investigate the characteristics and influencing factors of vascular calcification in maintenance hemodialysis patients. Methods The clinical data of 126 patients with maintenance hemodialysis were retrospectively analyzed. The indexes of maintaining blood dialysis patients and the effect of risk factors for vascular calcification were analyzed. Results The two groups showed significant differences in gender， age， diabetes mellitus， hypertensive history， fibroblast growth factor (FGF23)， daily dose of calcium and corrected serum calcium and multiplication of calcium and phosphorus levels （P＜0.05）. Age， dialysis age， diabetes mellitus and high sensitivity Creactive protein (hsCRP) were independent risk factors for vascular calcification in patients with maintenance hemodialysis. Conclusion The patients with vascular calcification is common in hemodialysis， and gender， age， diabetes history， hypertension， correction of calcium， calcium and phosphorus product are all risk factors of vascular calcification.

RIFLE criteria in nephrological consultation in patients with acute kidney injury after surgery

Cao Qiqi1， Huang Junyue2， Chen Wei3， Zhang Yi3， Guo Zhiyong3

2017, 32(10): 861-864. doi:10.3969/j.issn.1004-583X.2017.10.009

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Objective To evaluate the application of RIFLE criteria in the nephrological consultation in patients with acute kidney injury after surgery. Methods A total of 179 patients with acute kidney injury after surgery were retrospectively analyzed， and then classified as risk group， injury group， and failure group according to the RIFLE criteria based on the situation at the time of consultation. Mortality， hospital stay and others prognosis indexes among three groups were compared. Results Overall mortality was 32.4% and 60 days′ followup mortality was 38.5%. And the mortality in failure group (132 cases) was 37.9% compared with risk group (16.7%) and injury group (17.1%). There was no significant difference in hospital stay among three groups. Conclusion In this setting， the survival rate might be improved with early nephrological consultation and appropriate therapeutic measures. The RIFLE classification was a useful tool during the consultation.

Efficacy and safety of leflunomide and cyclophosphamide in sequential therapy of systemic lupus erythematosus

Ning Xiaoran， Zhang Fengxiao， Li Fang， Sun Lijun， Zheng Guimin

2017, 32(10): 865-868. doi:10.3969/j.issn.1004-583X.2017.10.010

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Objective To evaluate the efficacy and safety of sequential therapy with leflunomide(LEF) and cyclophosphamide(CYC) in systemic lupus erythematosus(SLE). Methods Totally 45 patients with SLE were recruited and randomly divided into two groups treatment group and control group. Patients of recent onset who had not used any immunosuppressive drugs were given either Ⅳ cyclophosphamide for 12 weeks (intravenously 0.6 g for two weeks)， then were administrated with oral LEF for 12 weeks(20 mg/d) (treatment group) or Ⅳ cyclophosphamide (intravenously 0.6 g for two weeks)(control group) for 24 weeks. SLE disease activity index (SLEDAI)， clinical and immunological tests were performed in the patients. The efficacy and safety of the drugs were evaluated at 24 weeks after treatment. Results SLEDAI improved similarly in both groups after 24 weeks of treatment. Major adverse events in both groups were infection and alopecia. Conclusion CYC combined with LEF was more effective and safe in the induction therapy of SLE especially in reproductive aging female patients.

Risk factors of nonalcoholic fatty liver disease in males and value of body composition analysis

Bao Yun， Zhang Shu， Zou Beibei， Liu Qinyuan

2017, 32(10): 869-872. doi:10.3969/j.issn.1004-583X.2017.10.011

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Objective To analyze the risk factors of nonalcoholic fatty liver disease (NAFLD) in males and discuss the value of the body composition analysis for evaluating the severity of NAFLD. Methods A total of 260 male patients diagnosed as NAFLD were included in the physical examination. According to the diagnosis of ultrasonography， 161 cases were divided into mild group， 65 cases in moderate group， and 34 cases in severe group.In addition，158 healthy male adults without NAFLD served as controls.The changes of body composition were analyzed by body composition analyzer.Serum was collected to measure serum lipid，liver and kidney function，ect.Results Body weight， body mass index (BMI)， abdominal perimeter， waist hip ratio， neck circumference， body fat percentage， visceral fat area (VFA)， gamma glutamyl transpeptidase (GGT)， triglyceride (TG) and high density lipoprotein cholesterol (HDLC) were significantly different between the four groups. Alanine transaminase (ALT)， glutamic oxaloacetic transaminase (AST)， fasting blood glucose (FBG) and uric acid (UA) of moderate and severe NAFLD patients were significantly higher than those in control group. The severity of NAFLD was positively correlated to body weight， BMI， abdominal perimeter， waist hip ratio， neck circumference， body fat percentage， VFA， ALT， GGT， TG， FBG and UA. Significant negative correlation was found between the severity of NAFLD and the level of HDLC. FBG and TG were the risk factors of NAFLD. Conclusion Body composition analysis has a high value in the evaluation of NAFLD. The risk factors of NAFLD in men were FBG and TG.

Characteristics of type 2 diabetes mellitus patients with primary liver cancer by ultrasonographic and risk factor analysis

Huang Jie1，2， Nie Fang1， Yang Liwen2， Li Jing1

2017, 32(10): 873-876. doi:10.3969/j.issn.1004-583X.2017.10.012

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Objective To observe the characteristics of type 2 diabetes mellitus patients with primary liver cancer by ultrasonic method and analyze risk factors. Methods Eightyfive cases of type 2 diabetes mellitus patients with primary liver cancer were observed with color Doppler characteristics. A total of 87 patients with type 2 diabetes mellitus patients without any cancer who did the same examination at the same period were assigned as the control group. The risk factors were analyzed by multivariate analysis. Results Ultrasonographic features of liver lesions in 85 patients with T2DM complicated with primary liver cancer: the right of the liver was mainly monotonous. Most of the lumps grew regularly and had clear boundary. The echo image inside of lumps was mostly hypoechoic and the size of lumps ranged between 3 to 5 cm. The liver right lobe was the main one， the shape was regular and the boundary was clear. The echo of the lesion was mainly hypoechoic， and the size of the lesion was between 35 cm. Doppler ultrasonic results: lesions within and around the blood flow were mostly Ⅲ class， showing highspeed and highresistance blood flow spectrum. The logisitic regression analysis showed that gender， age， drinking， HbA1C and HbsAg (+) were independent risk factors. Conclusion The two dimensional and Doppler ultrasonic characteristics are valuable for diagnosis of the type 2 diabetes mellitus patients with liver cancer. Male， age， drinking， HbA1c and chronic hepatitis B are independent risking factors in type 2 diabetes mellitus patients with prtmary liver cancer.

Efficacy of apatinib in secondline treatment failure of advanced nonsmall cell lung cancer

Yang Minghua

2017, 32(10): 877-880. doi:10.3969/j.issn.1004-583X.2017.10.013

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Objective To observe the clinical efficacy and adverse reactions of apatinib for secondline treatment failure of advanced nonsmall cell lung cancer. Methods Thirty patients received treatment of apatinib at a dose of 500 mg/day for two weeks， then increased to 750 mg/day if they could tolerate and maintain the therapy. The efficacy was evaluated by the imaging and testing tumor such as markers including CEA， CA199， CA125 and SCC. Results The clinical evaluation of the patients were complete remission 0 case， partial remission 9 cases， steady 16 cases， progess 3 cases，2 cases terminated the treatment due to adverse reactions， and the objective response rate was 32.1%(9/28)，disease control rate was 89.3%(25/28）.After four weeks′ treatment， CEA， CA199， CA125 and SCC were significantly reduced than the previous（P<0.05）.The effective rate on the prognosis of different metastatic sites were no significant difference （P>0.05）.The main toxicities were hypertension， oral mucositis and poor appetite（33.3%，30.0% and 23.3%）.Conclusion The treatment of apatinib in secondline treatment failure of advanced nonsmall cell lung cancer has better clinical efficacy， and toxicity could be controlled， so it was worth evaluating the longterm efficacy of apatinib for advanced nonsmall cell lung cancer.

Curative effect of oxcarbazepine on infants with partial epilepsy and immune function

Dong Lia， Li Xianghaib

2017, 32(10): 881-884. doi:10.3969/j.issn.1004-583X.2017.10.014

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Objective To analyze the curative effect of oxcarbazepine suspension in treatment of infants (≤3 years old) with partial epilepsy and effect on immune function. Methods One hundred and thirtyeight infants (≤ 3 years old) with partial epilepsy who received oxcarbazepine oral suspension treatment from May 2012 to January 2016 were chosen as observation group. The initial dosage was 8-10 mg/ (kg·d)， increased by 10 mg/(kg·d) every 7 days， the stable maintenance dose was 20-40 mg/(kg·d). Drug efficiency， complete control and adverse reactions were analyzed. Blood samples were taken from children before treatment and the third and sixth months after treatment. The children under 3 years old were selected as control group during the same period. Results The complete control rate in the 13 months，4-6 months and 7-9 months after medication of the observation group was 41.48%， 44.44% and 54.07% and the total effective rate was 80.74%， 83.70% and 85.93%， respectively. Adverse reactions occurred in 25 cases with a rate of 18.52%. Before treatment， IgA， IgG， ICAM1， CD3+， CD4+ and CD8+ in observation group were significantly different from those in control group (P<0.05)， at 3，6 months after treatment， IgA， IgG， ICAM1，CD4+，CD8+ and CD3+ were significantly different from those before treatment (P<0.05). Conclusion Oxcarbazepine oral suspension has good clinical effect in infants with partial epilepsy， not only can effectively reduce the frequency of seizures， but also can promote the normal immune state， and has less adverse reactions. The treatment compliance of children is better.

Establishing a point-scoring system to predict prostate biopsy outcome with PI-RADS v2

Yang Dashan， Peng Peidan， Pang 　Shiyu， Long 　Qicheng， Zhan Yaping， Tan Wanlong

2017, 32(10): 885-890. doi:10.3969/j.issn.1004-583X.2017.10.015

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Objective To explore risk factors of prostate biopsy and to establish scoring a system to predict prostate biopsy outcome and reduce unnecessary prostate biopsy through PIRADS v2.Methods A total of 392 patients who had accepted prostate biopsy were enrolled from August 2013 to June 2017 in Nanfang Hospital retrospectively， 267 patients in modeling group and 125 patients in authentication group. Risk factors were analyzed in diagnosis performance for prostate cancer. According to the results of Logistic regression analysis， a scoring system was developed to predict prostate cancer. The scoring system was validated using patient data from the validation group.Results According to Logistic analysis， age， prostate specific antigen density(PSAD)， BMI， PIRADS， prostate volume were affecting factors for prostate cancer detection. Value of scoring system was set in accordance with regression coefficient. It ranked from -2 to 9.5 scores. Calculating overall score was used to draw receiver operating characteristic curve of modeling group and authentication group. The areas under the ROC curve were 0.923 and 0.895. Patients acquired a score ≤3 scores with low risk of prostate cancer. The patients who gained more than 3 scores met a high risk of prostate cancer. Conclusion The scoring system combined with PIRADS v2 has outstanding diagnosis performance for the risks in prostate cancer. The patients with scores lower than 3 do not recommend prostate biopsy as minimal risk of prostate cancer. In view of high risk of cancer， patients obtained 3 scores need prostate biopsy. The rational use of PIRADS v2 can help set up scoring systems.

Expression on interferon-γ， interleukin-10(IL-10)， IL-17 and helper cell T-17 in patients with ulcerative colitis: a meta-analysis

Gao Hongliang， Zhou He， Yao Ping

2017, 32(10): 891-895. doi:10.3969/j.issn.1004-583X.2017.10.016

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Objective To evaluate the association of interferon-γ(IFN-γ)， interleukin-10(IL-10)， interleukin-17(IL-17) and helper cell T-17(Th17) cells proportion with ulcerative colitis (UC). Methods Analysis of all related literatures in PubMed (1996-2016)， CBM (1998-2016)， CNKI (1958-2016)， WanfangData (1999-2016) and VIP (19892016) was made. Randomized controlled trials involving in serum IFN-γ， IL-10， IL-17 and Th17 cells proportion in UC patients were selected. All statistical tests were performed with RevMan5.3 software. Results A total of 20 articles and 1 151 patients were included. The results indicated that IFN-γ in UC group was significantly higher than in control group. IL-10 in UC group was significantly lower than that in control group. IL-17 in UC group was significantly higher than that in control group. Th17 cells proportion in UC group was significantly higher than that in control group.Conclusion Existing evidences suggest that IFN-γ， IL-10， IL-17 and Th17 contribute to the pathogenesisi of UC.

Effectiveness and safety of vitamin D in treatment of patients with asthma during remission stage: a metaanalysis

Hao Hongxia， Tian Xinrui

2017, 32(10): 896-900. doi:10.3969/j.issn.1004-583X.2017.10.017

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Objective To comprehensively analyze the effect of vitamin D on asthma and investigate whether vitamin D supplementation reduces acute exacerbation of asthma patients， improves lung function， exhaled nitric oxide fraction (FeNO) and other clinical indicators，to systematically evaluate the safety and efficacy of vitamin D supplementation in asthmatics. Methods We searched Pubmed，Embase，Medline，CNKI，CBM，VIP and Wanfang Data from database through computer for data as at March 8，2017. All of randomized controlled trials (RCTs) of vitamin D supplementation in patients with asthma were searched， and research literatures included in the RCTs were also traced．Two researchers independently conducted the strict quality evaluation and data extraction for the included studies and made a metaanalysis by using RevMan 5.3 software.Results Eight trials with a total of 1 026 patients with asthma were pooled in the final study.The metaanalysis showed the pooled RR of asthma exacerbation was 0.84 (95% confidence interval: 0.501.39)， but there was no significant difference (Z=0.69，P=0.49). FEV1 % improved (Z=2.40，P=0.02)，and serum 25hydroxyvitamin D significantly increased (Z=4.84，P<0.01).Conclusion Vitamin D supplementation can improve lung function，increase serum 25hydroxyvitamin D levels，but can not reduce the number of acute episodes of asthma.

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