Clinical Focus

Development of electrocardiology standardization in China

Yang Hu

2018, 33(12): 1013-1015. doi:10.3969/j.issn.1004-583X.2018.12.001

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As a routine clinical examination technique, electrocardiogram (ECG) has been widely used in clinic for it is simple, noninvasive and repeatable. However, the clinical practice reveals that there are still many detailed problems awaiting for a unified standard, which contributes to the gradual development of the standardization of ECG in China. The development mainly centered on the operation methods, noun terminology, measurement and diagnosis, analysis and coding, etc. This paper introduces the development of ECG standardization in China.

Intelligent analysis of electrocardiogram: a new era of assisted precision medical treatment

Lu Xilie

2018, 33(12): 1016-1017,1023. doi:10.3969/j.issn.1004-583X.2018.12.002

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Electrocardiogram (ECG) is one of the most common method in clinic. It is noninvasive, simple, rapid and cheap and has been widely used in clinic. However, the traditional ECG reporting method mainly relies on the manual measurement of electrocardiologists and technicians to analyze ECG and issue reports, which can not get rid of slow speed, low working efficiency and large deviation of measured data, affecting the reliability and accuracy of ECG reports. With the popularization of artificial intelligence, the importance of intelligent ECG analysis is increasingly important. ECG intelligence analysis uses computer to analyze ECG, measure necessary parameters, and then make correct diagnosis or evaluation according to clinical standard. It can reduce the workload of doctors and improve the accuracy of clinical index analysis. In this paper, the development background, present situation and prospect of intelligent analysis of ECG are reviewed.

Standardized method for clinical operation of ambulatory electrocardiogram

Li Jie1, Cui Junyu2

2018, 33(12): 1018-1023. doi:10.3969/j.issn.1004-583X.2018.12.003

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Ambulatory electrocardiogram（ECG）, also called Holter or Holter examination, is a simple, efficient, accurate and safe noninvasive examination for the evaluation of abnormal ECG in patients with cardiovascular dissease. It is widely used in the evaluation of cardiac arrhythmiasof heart disease patients,occurrence of myocardial ischemia, drug efficacy, the state of implantable cardiac electrotherapy devices such as pacemakers, etc. At present, ambulatory ECG has been widely used in clinical medical institutions.It is necessary to standardize the training of this technology. This paper refers to the relevant guidelines, consensus and expert suggestions, combined with the authors' experience, to write the standardized method of clinical operation of ambulatory ECG for clinical reference.

Standard data in surface electrocardiogram

Geng Xuhong

2018, 33(12): 1024-1026. doi:10.3969/j.issn.1004-583X.2018.12.004

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Surface electrocardiogram (ECG), as a basic method of physiological examination, is indispensable in daily clinical diagnosis and treatment, especially in that of heart disease. The diagnostic value of ECG and its simplicity and convenience make it an important basis for effective treatment of patients. Therefore, rapid and accurate diagnosis of ECG is of great significance in guiding clinical treatment correctly. However, the interpretation of ECG is far from being easy, especially when it comes to the complex standard parameters of ECG. It is particularly important to master them. This paper reviews the normal indexes of ECG in different ages.

Effect of butylphthalide injection on acute cerebral infarction patients with defferent TOAST types

Zhang Jiang, Han Xue, Song Fangfang

2018, 33(12): 1027-1030. doi:10.3969/j.issn.1004-583X.2018.12.005

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Objective To explore the efficacy of butylphthalide injection in the treatment of different subtypes of acute cerebral infarction(ACI), based on TOAST classification. MethodsA total of 299 patients with ACI were randomly divided into two groups . The control group was treated according to the guidelines for the diagnosis and treatment of acute ischemic stroke, while the observation group was treated with butylphthalide injection on the basis of the guidelines. All patients were carried out by TOAST typing on admission procedures. NIHSS score and BI score were recorded in two groups of patients on admission and after two weeks and four weeks of treatment. Comparison was performed in the curative effect of two groups and different subtypes of patients.Results Compared with the control group, the NIHSS score of observation group decreased while BI score increased after two weeks and four weeks of treatment(P<0.05). The curative effect of observation group was better than that of control group(P<0.05). After the treatment, the NIHSS of the three subtypes all saw decrease, while BI scores increased. However, LAA subtype changed more obviously. Significant statistical differences existed among the three subgroups, and among the interactions between the groups, at different time(P<0.05).Conclusion Butylphalide injection has a good effect on ACI. The effect of butylphthalide injection on LAA subtype are better than that of CE subtype and SAO subtype.

Preoperative localization and surgical outcome analysis of multifocal refractory epilepsy

Wang Mina, Gao Weib, Hu Xiaoweia, Wu Chaob, Xu Mina

2018, 33(12): 1031-1035. doi:10.3969/j.issn.1004-583X.2018.12.006

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Objective To investigate the clinical features, preoperative location, postoperative efficacy and surgical complications of multifocal refractory epilepsy.Methods The clinical data of 11 patients with multifocal refractory epilepsy from July 2013 to April 2018 in the Epilepsy Center of the First Affiliated Hospital of Soochow University were retrospectively analyzed, and all the paitents were conducted longterm VideoEEG monitoring (VEEG), magnetic resonance imaging (MRI), positron emission computed tomography (PETCT) and PET/MRI coregistration. Local lesions or enlarging lobectomy was implemented by the monitoring of electrocorticogram (ECoG) during operation．Postoperative scores were performed according to Engel classification and followed up.Results Of 11 patients, encephalomalacia was found in 7 cases, ulegyria in 1 case, schizecephaly in 1 case, encephalomalacia combined with ulegyria in 2 cases. After 360 months' followup, 7 cases(63.6%) fell into gradeⅠ, 2 cases(18.2%) grade Ⅱ, 1 case (9.1%) grade Ⅲ, 1 case (9.1%) grade Ⅳ. About 63.6% of patients had no seizures and the total effectiveness was 90.9%. Of 11 patients, infection was detected in 2 patients, hydrocephalus in 1 patient,aggravated visual field deficits in 1 patient, and right limb hemiparesis in 1 patient; no patients died during the operation. Conclusion For multifocal refractory epilepsy, a good prognosis can be obtained by surgical treatment based on accurate preoperative evaluation.

Effects of 24hour ambulatory blood pressure on cognitive function in patients with Parkinson's disease

Ying Li, Zhang Chongsheng, Wang Wenan

2018, 33(12): 1036-1039. doi:10.3969/j.issn.1004-583X.2018.12.007

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Objective Patients with Parkinson's disease (PD) are commonly accompanied by abnormal dynamic blood pressure (ABP) and cognitive impairment and the exact mechanism of the cognitive impairment is unclear. We aim to investigate the relationship between ambulatory blood pressure (ABP) and cognitive function in PD patients.Methods 24 h ABP monitoring were taken in 60 cases of patients with idiopathic PD, compared to 40 healthy controls with matched age and gender.24 h ABP monitoring and MoCA scores were performed in the two groups. The change of the two groups of ABP were compared and the influence of ABP change in cognitive function was evaluated.Results The incidence of nondipping blood pressure in PD group was significantly higher than that in control group (P=0.028).Night mean blood pressure (nMBP) of PD group increased significantly compared with control group (P=0.049).The decrease of mean arterial blood pressure in PD group at night (MABP%) was significantly lower than that in the control group (P=0.022).MoCA score of PD group was significantly lower than that of control group (P=0.024).MABP%, UPDRS, age and education years in PD group had significant influence on MoCA score (P=0.04, 0.012, 0.015, 0.020), while education years and age in control group had significant influence on MoCA score (P=0.010 and 0.035, respectively). Conclusion MABP% is an independent risk factor for PD patient’s cognitive decline rather than normal people.

Research on remote management effects of hypertensive patients

Ma Liang1, Shi Yu2

2018, 33(12): 1040-1043,1048. doi:10.3969/j.issn.1004-583X.2018.12.008

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Objective To implement remote management of outpatients with hypertension through an information network platform and to investigate the significance in improving the blood pressure compliance rate of patients. Methods A total of 1 294 outpatients with hypertension from January 2016 to January 2018 were selected as observation objects and were randomly divided into control group (646 cases) and intervention group (648 cases). The control group was followed up routinely. The intervention group was excluded from routine followup. Through the WeChatbased information network interactive platform, patients were given with regular monitoring of blood pressure and timely medical guidance in conjunction with changes in blood pressure. Comparison was made in the living intervention, compliance and blood pressure compliance rate between two groups. The blood pressure was detected between two groups before and after study. Results The intervention group had statistically significant difference in the lowsalt diet, weight control, moderate exercise, smoking cessation, alcohol restriction, psychological balance and other life interventions(P<0.01). The intervention group was in compliance with the patients' blood pressure. The rate was statistically significant when comparing with the control group (P<0.01). Conclusion The remote management of hypertensive patients through information network can improve the blood pressure compliance rate.

Relationship between the resting heart rate on admission and prognosis of heart function in chronic heart failure patients with hypertension

Liu Xin1, Zhang Qi2, Geng Wei2, Li Hua2, Yuan Xiaoyu1, Zhao Lin1

2018, 33(12): 1044-1048. doi:10.3969/j.issn.1004-583X.2018.12.009

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Objective To analyze the relationship between the resting heart rate(RHR) on admission and prognosis of heart function in chronic heart failure patients with hypertension.Methods All 250 chronic heart failure patients with hypertension were divided into three groups according to the levels of RHR on admission: RHR1 group, RHR＜70 beats/minute(bpm);RHR2 group, 70 bpm≤RHR＜90 bpm;RHR3 group, RHR≥90 bpm. Echocardiographic parameters including left ventricular enddiastolic diameter(LVEDD) and left ventricular ejection fraction(LVEF) were measured, and the prognosis of heart function on admission, discharge, followup were collected. The differences in all indicators and curative effects were compared between groups.Results With the increase of RHR on admission, LVEF showed a decreasing trend (P<0.05), while LVEDD and BNP increased gradually, and those were the highest in RHR3 group (P<0.05). The discharge effect and followup effect of RHR1 group and RHR2 group were both better than those of RHR3 group (P<0.05); RHR on admission of RHR3 group was negatively correlated with discharge effect (r=-0.251, P<0.05); the difference in RHR between admission and discharge was positively correlated with both discharge effect and followup effect in RHR2 group and RHR3 group (associated with discharge effect ［r=0.197, 0.279, P＜0.05］, associated with followup effect ［r=0.214, 0.321, P＜0.05］).Conclusion In the heart failure patients with hypertension，the faster of RHR，the lower the heart function of left heart，the worse of the discharge effect and followup effect.But the positive and reasonable control of heart rate is conducive to the prognosis of heart failure.

Influence of preinform template on time of informed consent for primary percutaneous coronary intervention in patients with acute myocardial infarction

Xiang Jun, Liu Cheng, Wang Yan, Wang Lei, Li Wei, He Haiyan, Cao Na, Pan Lei

2018, 33(12): 1049-1052. doi:10.3969/j.issn.1004-583X.2018.12.010

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Objective To explore the effect of preinform template on time of informed consent for primary percutaneous coronary intervention(PPCI) in patients with acute STsegment elevation myocardial infarction(STEMI). Methods Patients with acute STEMI and treated with PPCI from June 2016 to May 2017 period in 97th hospital of PLA were selected into conventional inform group, and that from June 2017 to May 2018 period into Template inform group. For the latter, standardised preinform template were employed. The catheter rooms were started as soon as informed consents were got and PPCI implemented in the two gropes. Informed consent time and D to B time were contrasted. Results The basic clinic condition and infraction related arteries were comparable.The informed consent time of Template inform group(n=52) was significantly shortened (［16.1±13.3］ min vs ［26.8±12.5］ min，P<0.001) and D to B time was reduced (［79.7±21.5］ min vs ［93.4±22.0］ min，P<0.05) than that of the conventional inform group(n=68). Conclusion The preinform template can improves informed consent for PPCI in patients with acute STEMI and shorten time of informed consent and D to B.

Application of oxygen desaturation index, StopBang questionnaire and Epworth sleepiness scale in screening of obstructive sleep apnea in bus drivers

Wang Yongchong1, Ji Yunxin2, Ruan Liemin2

2018, 33(12): 1053-1056,1060. doi:10.3969/j.issn.1004-583X.2018.12.011

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Objective To evaluate oxygen desaturation index (ODI), StopBang questionnaire and Epworth sleepiness scale (ESS) in screening of the bus drivers with obstructive sleep apnea syndrome (OSA).Methods A total of 195 cases of bus drivers with snoring between December 2016 and January 2018 (177 males and 18 females) were randomly selected. StopBang questionnaire, ESS, nocturnal oximetry monitoring and the overnight polysomnography （PSG） monitoring were conducted among them. Based on the severity of OSA which was determined by PSG, the participants were classified into four groups: primary snoring (<5 events/h), mild (-15 events/h ), moderate (-30 events/h ), and severe (≥30 events/h ). Sensitivity, specificity, positive predictive value, negative predictive and the receiver operating characteristics curve of three detection methods were calculated. Results Using mildmoderatesevere (≥5 events/h), moderatesevere (≥15 events/h), and severe (≥30 events/h) OSA as cutoffs, StopBang questionnaire had the highest sensitivity; ODI had the largest area under the receiver operating characteristics curve, while ESS had the lowest sensitivity. Application of StopBang questionnaire, combined with ODI, boasts the highest diagnostic accuracy.ConclusionCombination of StopBang questionnaire with ODI has great value to assess OSA in bus drivers.

Clinical and neurophysiological features in patients with impaired glucose regulation

Zhang Leia, Li Zhanhuib, Yang Lic, Li Jinga

2018, 33(12): 1057-1060. doi:10.3969/j.issn.1004-583X.2018.12.012

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Objective To study the clinical and electrophysiological features in patients with impaired glucose regulation(IGR). Methods Motor nerve conduciton velocity(MCV) and Sensory nerve conduciton velocity(NCV) were performed in 40 IGR patients (IGR group), 40 diabetes mellitus patients (T2DM group) and 30 controls (control group). The fasting blood glucose, postprandial blood glucose, glycosylated hemoglobin (HbA1c) and the blood lipid were analyzed.Results Compared with the control group, NCV of the tibial nerves in IGR group was significantly slower（P<0.05）. NCV in T2DM group of every nerve was significantly slower（P<0.05）, and was significantly slower in the tibial nerves and peroneal nevers（P<0.01）. More severe abnormal never conduction was found in lower limbs than in upper limbs in IGR group and T2DM group. The abnormal degree was more severe in sensory nerve than in motor never（P<0.05）. Diabetic peripheral neuropathy is associated with FBG, 2 hPBG and HbA1c in patients with IGR. Conclusion The most common clinical and electrophysiological manifestation of diabetic neuropathy is sensory disturbance, which is more severe in lower limbs. Subclinical diabetic peripheral neuropathy in IGR patients can be detected by electrophysiological examination which is useful to verify the range and extent of the nerve lesion involved in the early stage of diabetic peripheral neuropathy.

Study on the cutoff value of thyroid stimulating hormone during screening of congenital hypothyroidism in the newborns in Shijiazhuang

Ma Cuixia, Feng Jizhen, Feng Lulu, Bai Xue, Jia Liyun

2018, 33(12): 1061-1064. doi:10.3969/j.issn.1004-583X.2018.12.013

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目的分析石家庄市新生儿疾病筛查诊治中心168 107例新生儿先天性甲状腺功能减低症（CH）的筛查数据，探讨建立石家庄市筛查CH切值的方法，避免漏诊和资源浪费，并指导后续的CH筛查工作。方法采用全自动时间分辨荧光检测仪(GSP2021型)测定石家庄市168 107例新生儿足跟血干血斑的促甲状腺素（TSH）浓度，采用百分位数法和ROC曲线建立实验室TSH的筛查切值，并进行比较分析。结果 168 107例新生儿TSH浓度呈现偏态分布，确诊患儿80例，其中CH患儿62例，高TSH血症患儿18例，CH检出率为1/2 711。以99%的百分位数和经验确立筛查切值分别为8.2 μIU/ml和9.0 μIU/ml，分别导致3例患儿和8例患儿漏筛。采用ROC曲线得到的TSH切值为8.0 μIU/ml，此时约登指数最高，无漏筛情况。结论比较不同方法最终确定的TSH水平8.0 μIU/ml作为石家庄市新生儿疾病筛查促甲状腺激素的筛查切值。

Endovascular therapy in progressive wakeup stroke: a case report and literature review

Du Juan, Cai Yiling, Cui Yongqiang, Wu Zheng, Duan Wenbo, Zhang Zhaolong, Yu Yijiao

2018, 33(12): 1065-1070. doi:10.3969/j.issn.1004-583X.2018.12.014

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Objective To investigate the clinical efficacy of intravenous thrombolysis and endovascular therapy in Wakeup stroke (WUS) patients selected by multimode imaging. Methods One WUS patient was treated with intravenous thrombolytic bridging arterial thrombolysis and emergency stent implantation in the 306th Hospital of PLA and followed up for 90 days. The clinical data were summarized and analyzed. Results After intravenous thrombolysis, the symptoms were partially relieved, but aggravated again. Then thrombectomy was performed and severe middle cerebral artery stenosis was found. After thrombectomy, the blood flow could not be maintained and emergency stent implantation was given. The course of the disease was complex, however, the final outcome was good. The patient recovered with NIHSS 0 score and mRS 0 level in 90 days followup. Conclusion For WUS patients, intravenous thrombolysis and endovascular therapy are safe and effective after multimode imaging.

Diagnostic efficacy and safety of endobronchial ultrasoundguided transbronchial needle aspiration in intrathoracic tuberculosis: a meta analysis

Zhang Meng, Chen Huidong, Zhan Zhihua

2018, 33(12): 1071-1076. doi:10.3969/j.issn.1004-583X.2018.12.015

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Objective To evaluate the efficacy and safety of Endobronchial UltrasoundGuided Transbronchial Needle Aspiration (EBUSTBNA) in Intrathoracic Tuberculosis(TB).Methods Qualified studies were retrieved from PubMed and the Cochrane Library. Metadisc sofeware was applied to date analysis. The pooled sensitivity, specificity, likelihood ratios, the area under the summary receiver operating characteristic(ROC)and Q point(Q*) were calculated. And Metaregression was used to analyze the heterogeneity. Results Ultimately 19 studies with 1784 patients were included. The pooled sensitivity and specificity of EBUSTBNA for diagnosis of intrathoracic TB were 0.78 (95% confidence interval ［CI］,0.740.81) and 1.00 (95%CI=0.991.00), respectively. The positive LR was 54.61(95%CI=30.5797.57); and the negative LR was 0.24 (95%CI=0.190.31). The area under the summary ROC curve was 0.943, and the Q* was 0.881. Metaregression showed that region difference and research type were associated with heterogeneity, the sensitibity of EBUSTBNA for diagnosis of intrathoracic TB in European was 0.17 （95%CI=0.030.83, P=0.03） higher than in Asian, prospective study with high sensitibility of 0.20（95%CI=0.040.95，P=0.04） compared with the retrospective.The difference was statistically significant. Only 1 serious complication of septicopymia occurred. Conclusion EBUSTBNA is an effective and safe diagnostic tool for intrathoracic TB, especially in patients with negetive sputum of mycobacterium tuberculosis and intrathoracic lymphadenopathy.

Interpretation of the consensus on diagnosis and management of inflammatory bowel disease(Beijing, 2018) from the perspective of diagnosis of Crohn's disease

Guo Yahui, Niu Weiwei, Zhang Xiaolan

2018, 33(12): 1077-1079,1082. doi:10.3969/j.issn.1004-583X.2018.12.016

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In May 2018, the consensus on diagnosis and management of inflammatory bowel disease (Beijing, 2018) was published on Chinese Journal of Digestion, which was formulated by the Inflammatory Bowel Disease Group of the Chinese Medical Association Digestive Diseases Branch. The progress of the diagnosis and management of inflammatory bowel disease was updated on the basis of the 2012 consensus, providing canonical diagnosis and normative treatment for the medical personnel. This paper focuses on the diagnosis and management of Crohn's disease, aiming Crohn's disease to help clinicians improve their understanding of the new consensus, the diagnosis and treatment of CD.

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